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Post by Jaclynn & Willow on Aug 16, 2019 9:54:28 GMT -7
Willow's cervical disc surgery 12/Aug/2019 —mini dachshundHello everyone, thank you for this wonderful resource on IVDD. I'm Jaclynn, I'm here for my miniature dachshund Willow (6 yrs old). We are located on Vancouver Island, BC, Canada.Willow weighed 7.3 kg when we brought him to our primary vet on Aug.9. On Aug.8 I came home from work and Willow was not his usual self - about 25% his normal excitement when I got home, walking a little strange, decreased appetite and energy. We kept an eye on him for the evening and he seemed to be getting worse. By the morning of Aug.9 he was not using his right front leg and was having difficulty walking, he didn't move around during the night to find his perfect cozy spot and instead stayed exactly where we put him in bed all night. I called our primary vet as soon as they opened and got him an appointment for that day. I left work early so I could be with Willow until the appointment and he was really struggling to walk. Couldn't pee outside without tipping over. Our vet said he had no feeling in his front right leg and back leg was at 50%. She urged us to get a diagnostic image done ASAP, our options were CT scan on the island, or ferry ride + travel to Vancouver for an MRI. Our local emergency/surgery clinic agreed to take him, and he was admitted overnight. The vet we saw there ( at WAVES) agreed with his lack of leg movement/feeling but said deep pain was still present in the front right leg. CT scan on Aug.10 showed lots of calcification in a cervical disc with herniation into the spinal column, as well as a couple more cervical discs showing calcification, and a disc lower in the back starting to calcify. The surgeon was confident with the CT scan and recommended surgery to remove pressure on the spine, scheduled for Aug.12. Willow's condition did not get worse from Aug.9-11 but he was unable to walk without falling over. DR. CHRISTIAN BOLLIGER, (surgeon, DACVS) did the surgery on Aug.12. He assured me this was a standard procedure for him and he has 30 years experience. (Although I researched and he is not registered with ACVIM/ACVS). Surgery went well (surgery was done below the neck area rather than the back) removed much of the problem disc as well as some calcification in the other ones close by in the neck. The disc starting to calcify lower in the spine was not touched. Willow has been on meloxicam but they were switching him to steroids starting Aug.14. I'm not sure what other medications he has been on while in hospital, or if this included a stomach protector [Moderator's Note. Please do not edit
7.3 kg/ 16.09 lbs
Meloxicam stopped on date?
name of Steroid started w/o 5-7 days washout
name of pain medications?
Double GI protection with switch from Meloxicam to steroid
sucralfate
Pepcid AC (famotidine)]He's been there since Aug.9, was hoping to be able to bring him home Aug.14 but now the doc says Aug.17. We (my partner and I) went to visit yesterday (Aug.15) and Willow was shaking/trembling a lot at the beginning of the visit but seemed happy to see us. He had some little barks for the tech that came to check on us (definitely not his full bark). He was wrapped up in a blanket burrito for the visit but I felt some movement in the back legs. The doc told us after surgery all of his legs were quite weak. Willow has been receiving some massage and PT while in hospital. The surgeon also said to visit (we only missed 2 days of visiting during this ordeal - the day of surgery and Aug.14). Today (Aug.16) I will visit him by myself in the AM, then my partner and I will visit in the evening. I will hear from the surgeon today (aug.16) how Willow is doing. He has been peeing where he is ( cannot walk) and I'm not sure how the poops are going. He's eating well but not too keen on drinking water, when we visited we gave him water with an oral syringe which he was fine with. I have two recovery suites set up for him when he returns home. One for the living room and one for the bedroom. Lots of fleece blankets that I still need to cut to size, also still need to attach his water/food bowls to the side of the suite, also need to wrap bed/memory foam pads in garbage bag and buy pee pads (all on the to do list today!) I have found dodgerslist extremely helpful and have been watching as many videos and doing as much reading as I can find that is relevant to cervical disc surgery and recovery. |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 16, 2019 12:29:49 GMT -7
Jacklyn, welcome to the Forum. Really excellent to hear you are reading in an effort to get up to speed on IVDD. Still very early in the nerve healing department. There are no medications that can heal nerves. The body does that on its own with time. Maybe best to think in terms of months rather than day's weeks. I bet your mind is flooded right now with concerns, questions. Now is the time to jot those things down. Here's a starter list of questions to which you can add some of your concerns to ask your surgeon: www.dodgerslist.com/literature/dischargequestions.htm Just for your own IVDD self education, you will want to know the reason behind switching from Meloxicam to a steroid. Since it appears their may not have been a washout of 5-7 days from the Meloxicam before the start of the steroid, you will want to ensure Willow GI tract was protected from the double jeopardy of deadly bleeding ulcers by the use of two (2) protectors: sucralfate + Pepcid AC (famtodine) This page is good reading by Dr. Isaacs, ACVIM (neurology) as he explains many post-op questions for our IVDD community: meds, crate rest, PT and discharge day. www.dodgerslist.com/literature/surgery.htmSee 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.htmDogs are not discharged until IV pain relievers can be moved to oral pills that can be continued at home. Owners are given a lesson on expressing the bladder on discharge day if the dog still needs more time to self repair bladder function. Excellent video on expressing both for urine and for poop if he is not continent by 8/17. View it before discharge day so you will get more out of the lesson: www.dodgerslist.com/literature/Expressing.htm What was the reason for extending Willow's stay til Aug 17th?
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Post by Jaclynn & Willow on Aug 16, 2019 14:15:55 GMT -7
Extending Willow's stay: the surgeon wants to see some more progress from Willow before he comes home. I will phone today and ask them to pass along my question "is sucralfate and famotidine being given to protect his stomach?". They say he is peeing on his own ( they are not expressing his bladder), however he is just peeing in the bed and not outside. He has some movement in his back legs but is not using his front legs at all. Should I push to take him home tomorrow (Aug.17)? This stay does seem very long. The surgeon is considering another CT scan as well, to see how everything is doing in his neck I believe, as well as possible longer stay?? They are also watching out for an "unstable neck" which I was told can present within 2 weeks of surgery. He is no longer on IV meds (no IV present when I visited today), should I be pushing harder to take him home? I just called and he is indeed on both of those stomach protecting drugs [sucralfate + Pepcid AC/famotidine] and has been since surgery. Edit: also we are in Victoria, not Vancouver  If we were in Vancouver we would've had much faster/direct access to MRI but there are none on the island for animals. |
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Post by Romy & Frankie on Aug 16, 2019 14:58:49 GMT -7
What kind of progress is your surgeon looking for? Nerve healing takes a long time. Nero function can take weeks, months or in rare cases even years to return.
A dog that is peeing in his bed is not really peeing unless he is not being taken out to pee often enough and has no choice. There are two ways that urine can be released. One is where the brain sends a message to the bladder down the spinal cord and which allows the dog to choose when to release urine, that is bladder control. The dog is actually peeing. The other way is when the spinal cord is damaged and no messages can be sent, the body will use reflexes. Similar to your pulling back your hand without thinking when touching a hot stove. Reflexes for a dog can kick in when the bladder is overstretched and full of urine. This is called overflowing…not a good thing. Overflowing will invited bladder infection and all the overstretching can permanently ruin bladder tone. Overflowing means the dog's bladder needs to be manually expressed so the dog stays dry.
I think you should speak to the surgeon about this. If Willow's bladder is overflowing it must be expressed to stay healthy. This is common for paralyzed dogs. If he has bladder control and he simply is not being taken out often enough I would strongly advocate for Willow to get enough potty breaks. Either way, no dog should have to lay in urine.
Not having bladder control is no reason for Willow to stay in the hospital. You can learn how to express him. You will need a hands on lesson from the vet to learn how to do this. This sounds scary. I was terrified when Frankie came home from surgery and I realized I had to express him. I got a lesson from my vet (I needed more than one). I practiced and I learned.
Definitely have the vet or vet tech show you how to express before you take Willow home unless he has bladder control. When the surgeon says peeing on his own, ask what exactly is meant by that. Bladder control can be verified by "sniff and pee". Take Willow to an old pee spot or where another dog has peed. If he urinates right after, that shows a message has been able to travel from the brain to the bladder which indicates bladder control.
Why is the surgeon considering another CT scan? Does he feel that some of the disc material was missed and more surgery might be needed? I am not sure what is meant by an "unstable neck". I would ask for more information about this.
Dogs always do better at home but it is hard to make a decision on this without fully understanding why the surgeon wants Willow to stay in the hospital.
Please let us know what the surgeon says when you speak to him.
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Post by Jaclynn & Willow on Aug 16, 2019 17:37:17 GMT -7
Thank you for your reply. As for being taken out to pee what should I expect them to be doing? Willow cannot stand, cannot currently use his front legs, and his back legs are weak. Should he be supported by someone's hands or harness/sling? His incision is under his neck/chest not the back, so I could see a harness putting pressure on the surgical area.
I am still waiting to speak with the surgeon about the exact signs they're looking for to be able to send him home/reasoning for another possible CT scan.
Another edit:
The unstable neck: since the surgery was in his neck, I was told there is risk of the neck being unstable and requiring further surgery to fuse some vertebrae (I was told this risk pre-op and that is rare)
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 16, 2019 17:57:52 GMT -7
Jacklynn, the only way there is proof he has bladder control and choosing where to releases urine is the sniff and pee test. Him peeing in his crate is no proof as reflexes can cause the bladder to release urine (overflowing), but not all the urine. Ask them has he proved bladder control by them taking him outdoors. Setting him on another dog's pee spot while they support his front/back legs in the usual way they do it at the hospital. Did he sniff, then did he release urine? That is proof that a head level involvement (sniffing) had the brain send a message all the way down the cord to the bladder. The brain directed release of urine. Otherwise overflowing can cause urinary tract infection. The urine reflex does not get out quickly becomes a breeding ground for bacteria. If he truly does have brain control of his hind legs, then he may well have bladder control. You need to speak with a person of knowledge, like the surgeon, to confirm about bladder control. Vet techs should know, but some get it wrong about bladder control. Nerves heal typically in the reverse order of the damage to the spinal cord: 1. Deep Pain Sensation (Only correctly identified by a specialist.) 2. ? Tail wagging with joy at seeing you or getting a treat or meal. 3. ? Bladder and bowel control verified with the "sniff and pee" test. 4. ? back Leg Movement, and then ? ability to move up into a standing position, and then wobbly walking. 5. Being able to walk with more steadiness and properly place the feet. 6. Ablity to walk unassisted and perhaps even run. More info: www.dodgerslist.com/literature/healingnerves.htmIs the surgeon Bolliger? |
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Post by Jaclynn & Willow on Aug 22, 2019 8:30:00 GMT -7
It's been awhile since I posted an update.
On Aug.18, our surgeon Dr.Bolliger said Willow was still in an unusual amount of pain and ordered another CT scan for Aug.19. The CT scan showed there was still some disc material in the spinal cord area. He said that during the first surgery he had removed a lot of the disc material and thought it had been enough because he had removed quite a lot. On Aug.20 Willow had a second surgery to remove more of the disc material. Dr. Bolliger was able to go through the slot he made the first time but also had to go farther than the first time. There was a higher risk of bleeding than the first surgery but Willow made it through. He said that when these disc herniations happen lower in the spine there is more room to work with, but the neck is a very tight space. Willow had a CT scan right after surgery to confirm enough disc material was removed.
My partner and I went to visit Willow yesterday Aug.21 (1 day post op) but he was still on a lot of pain medication (IV fentanyl), and there was a note on his pen for diazepam dosed by weight in case of seizure (he has history of seizures 1-3 times per month). He also had a catheter. He was pretty out of it. They are decreasing his pain medication and we will visit him again this evening (Aug.22).
Hoping he is on the road to recovery. He has been in the vet hospital for 2 weeks, even Dr.Bolliger said this is unusual.
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Marjorie
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Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Aug 22, 2019 9:32:01 GMT -7
I'm sorry to hear that Willow needed a second surgery, Jaclynn. That must have been very stressful for you all. It does sometimes happen that not all disc material is removed during the first surgery and a second one is needed. Prayers that Willow is now on the road to recovery and will be home with you soon. Please keep us updated.
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Post by Jaclynn & Willow on Aug 22, 2019 18:34:11 GMT -7
Thank you, it has been a very stressful time. Dr.Bolliger is hopeful Willow will be able to come home tomorrow. They will see if he can pee on his own, and if not, he will be coming home with a urinary catheter.
My original post said Dr.Bolliger is not registered with ACVIM/ACS, but I just found out he is registered with EBVS® (European Specialist in Small Animal Surgery). He is from Switzerland but now lives here in Victoria.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 22, 2019 18:48:46 GMT -7
Mostly owners are taught how to manually express the bladder. In rare situations as a last resort a cath would be used. Is Willow too fat so that feeling the bladder through a layer of fat makes expressing more difficult--- he doen't look fat in the picture? Have they tried manually expressing and Willow just is one of those dogs who is diffcult to press on the bladder to get release of urine? Do review the video on expressing in case there is not a reason he can't be sent home with you expressing. You would get a hands-on-top-of-your-hands type of expressing lesson there-- so you can learn what the bladder feels like and know how much pressure to apply. www.dodgerslist.com/literature/Expressing.htm In the preceeding link there is also a video on how to express for poop. Yes Dr. Bollinger is a "D" for diplomate ortho specialist with the acronym : DACVS www.wavesvet.com/dr-christian-bolliger |
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Post by Jaclynn & Willow on Aug 24, 2019 8:08:36 GMT -7
We were hopeful to take Willow home yesterday (Aug.23) but he took a turn for the worst. His tongue had a blue tinge and his breathing was irregular. They gave him naloxone to reverse his pain medication but that didn't seem to help much. They took a radiograph and his heart has enlarged one rib space bigger than it was pre-op. They gave him atropine and his heart did react. They're doing another better quality radiograph today and their internal medicine specialist Dr.Branter will be handling his case going forward. Dr.Bolliger is still optimistic that Willow will be able to come home this weekend. We find out more later today. We will be taught how to express his bladder before he comes home. He is not fat, they have been expressing his bladder there and this is when they noticed the irregular breathing and blue tinge. He has lost a lot of weight while in hospital  Dr.Bolliger says it is muscle loss from laying down for so long. They gave him a laser therapy treatment on Aug.22 |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 24, 2019 9:29:57 GMT -7
Jacklynn, good to heart the surgeon, Dr. Bollinger, is optimistic that Willow can come home this weekend. I know how happy that will make you and for sure Willow will love being back home in familiar territory and with his loved ones to keep him company. Please keep us us posted as you learn more.
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Post by Jaclynn & Willow on Aug 27, 2019 9:18:22 GMT -7
On Aug.24 Willow was able to come home with us. Dr.Bolliger went over home care/discharge instructions with us on Aug.23 but we weren't sure when we would be able to take him home. We went to visit Willow on Aug.24 but were surprised when they said he could come home. They did an echocardiogram on Aug.23 because of his low heart rate/DCM but didn't find anything of concern although we were not able to go over the results with Dr.Branter (they were crazy busy that day, maybe that's why..)
A vet tech taught us how to express his bladder before we left. We are expressing him in the prone position on a pee pad indoors. My partner and I both have pretty good technique now.
He has feeling in all legs but is very weak. We get some pushback from his back legs when doing exercises sometimes, and see a little bit of movement in his front legs. No standing or even supporting any weight on any of his legs yet.
His post op care: 6 weeks crate rest. Soft bedding and regular turns to avoid bed sores. Standing exercises for 2-3 minutes every 4 hours and thigh muscle massage. Range of motion exercises on all legs. Bladder expression every 8 hours. Evaluate incision site twice daily for swelling, redness, heat, pain, or discharge.
Medications:
buprenorphine 0.8 mg/ml - 0.25 ml every 8-12 hours, with food, for 5 days.
Baytril (Enrofloxacin) 30 mg once daily (evening) with food.
The night of Aug.23/morning of Aug.24 Willow had rapid, shallow, raspy breathing/panting from midnight until 9 am. We tried making him more comfortable, expressing his bladder, giving him water, food, his pain medication, petting him, but nothing seemed to help. We called WAVES and they told us to bring him in so they could put him on oxygen. We did this at 8:30 am on Aug.24. They ran some tests but there was no fluid in his lungs and when breathing normally his oxygen levels were fine. Because he cannot expand his chest to get deep breaths after the surgery he gets himself in a bit of a panic when he is trying to breath deeper, which makes things worse.
The doctor working that day told us we can hold various treats by his nose to encourage deeper breathing through sniffing the treats (and then give him the treat after). We have been doing this regularly. She said if we cannot get him to calm down and go back to breathing normally to bring him back in for oxygen again.
So for 3 nights in a row now Willow has been doing this rapid raspy breathing starting between 12-3 am until 6-7 am. We are getting pretty sleep deprived and nothing we do seems to help until he just seems to stop in the morning.
I am going to call today with some questions for Dr.Bolliger:
-What symptoms are we looking for with an unstable neck (we were told it could take 2 weeks post-op to see if this could be the case)
-What is the plan for pain control when the buprenorphine runs out (we have enough for today and tomorrow)
-What can we do to keep him calm during the night so everyone can get a good sleep
-Our "recheck with Dr.Bolliger in 10 days for incision control and assessment" is this 10 days post op or 10 days from discharge
If there are any other questions you think I should ask please let me know.
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Post by Romy & Frankie on Aug 27, 2019 13:28:35 GMT -7
I am very happy to hear that Willow was able to come home. Dogs do better at home in familiar surroundings. Nerves take a long time to heal so the fact that he cannot yet stand should not be concerning.
What does the vet think is the cause of the rapid breathing? Why can't he expand his chest to fully breathe some of the time? Is it because of the placement of the incision?
Sometimes panting can be caused by pain. I see that you gave him the buprenorphine when the rapid breathing started without really seeing a difference. Does it seem to you that the panting could be occurring when the pain meds are losing effectiveness? It is easier to keep pain at bay than to stop pain once it has started. Definitely find out what to do about pain when the buprenorphine runs out. Willow has been through a lot with two surgeries so close together and may need more pain meds for a longer time than most dogs who have had surgery.
If the rapid breathing is simply anxiety, there are medications that can keep a dog calm and may help him, and therefore you, sleep. Trazadone and Acepromazine are two that we see fairly frequently. I do think it is important for the vet to explain to you why this is happening.
Please keep us up to date after you have spoken to Dr.Bolliger. We will be wanting to hear.
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Post by Jaclynn & Willow on Aug 29, 2019 7:39:08 GMT -7
The cause of rapid breathing: he gets stressed or uncomfortable and tries to take a deeper breath but cannot due to lack of chest expansion. Lack of chest expansion is because of the incision location as well as muscle loss and/or nerve damage I believe. He then gets more worked up when he cannot get that big breath that he wants and it turns into a cycle of rapid breathing.
I do believe that pain is what kicks it off. Every time it happens, he is within an hour or two of his next pain medication dose. For Aug.27 and 28 I gave the ▲buprenorphine every 8 hours instead of every 12 and this helped prevent his rapid raspy breathing. I think you are right about keeping pain controlled rather than trying to get it back under control .
The night of Aug.27 and 28 he did not go into these raspy rapid breathing episodes for prolonged periods during the night. Those episodes only lasted 10 minutes or so during these nights before his buprenorphine dose.
We are continuing massage and physical therapy (at home) approximately every 4 hours. We are expressing his bladder every 6-8 hours and he has been having bowel movements every day or every other day.
I went back to WAVES on Aug.28 with Willow for a check up and to get a plan for his pain medication going forward. We saw Dr. Tamara MacDonald (DVM, MSc, DACVS-SA), doing a locum for Dr.Bolliger for this week.
She was happy with his neuro exam. He is gaining a little more strength and movement in his back legs which she says our massage and PT are helping with. There is feeling in the front legs but not a lot of strength or movement yet. He is holding his neck well. She gave me a handout with more exercises to do with him for the front and hind legs. She demonstrated standing exercises with Willow on top of two rolled towels placed beside each other to use as support under his tummy, while he puts weight on his front legs, alternated with back legs, for a total of 5 minutes, to be done 2-4 times per day.
Since Willow's second surgery his third eyelids have been up the whole time. She is optimistic they will go back down eventually. This happened after the first surgery as well but they went back down one day post op. We are on post op day 9 for the second surgery.
We received 3 more doses of ▲buprenorphine (enough to get through Aug.28 dosed 3x/day and 1 dose for Aug.29).
Started ✙gabapentin 37.5 mg 2x/day on Aug.28 with the option of increasing to 3x/day.
Starting prednisone 2.5 mg 2x/day for 3 days (Starting today Aug.29), 1x/day for 3 days, and 1x/day every other day for 3 days.
Famotidine 2.5 mg daily (Started Aug.28)
[Moderator's Note. Please do not edit
7.3 kg/ 16.09 lbs
Meloxicam stopped on date?
prednisone 2.5mgs 2x/day for 3 days then taper
buprenorphine 0.8 mg/ml - 0.25 ml ▲3x/day
✙gabapentin 37.5 mg 2x/day
Baytril (Enrofloxacin) 30 mg 1x/day
famotidine 2.5mgs 1x/day]
I have a follow up phone call with Dr.MacDonald today Aug.29
I will be asking:
-What if his pain is not controlled by the prednisone with gabapentin (no more opioid pain med)
-How will I tell if he is in pain and not whining for attention (this question is from my partner, I feel I will be able to tell but it would be nice to get a clear idea of what EXACTLY I'm looking for)
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 29, 2019 7:54:42 GMT -7
Hope the addtion of gabapentin plus the 3x/day increase of buprenorphine will do the trick.
Most of these pain meds do not fully control pain unless you give them at the prescribed every 8 hr. The level of the drug decreases too much at every 12 hrs and pain can surface.
Any hint of pain, please alert your vet to get the meds furthr adjusted:
SIGNS OF PAIN:
◻︎ shivering-trembling ◻︎ yelping when picked up or moved
◻︎ 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
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Post by Jaclynn & Willow on Aug 29, 2019 9:12:11 GMT -7
Thank you. We are stopping the buprenorphine today (last dose due at noon), switching to prednisone and gabapentin. This is what I'm a bit nervous about.
Willow doesn't move much but I will watch out for shivering/trembling, yelping, tight tense tummy, and not eating.
Since the second surgery, the whole time, he:
-cannot move himself other than his head and neck. Some back leg and front leg response but he can't move himself with them.
-hasn't been his perky normal self
-mostly looks around with his eyes but can hold his neck when we do the standing exercises, also looks around using his neck sometimes
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Post by Jaclynn & Willow on Aug 30, 2019 17:06:23 GMT -7
I am happy to report the med switchover went well! He was a bit whiny overnight but we got through it. He kept trying to bark yesterday (not much sound coming out of him).
Today he is much perkier, more energy, big appetite (I'm going to have to get him some low calorie snacks!!) and the gabapentin/prednisone combo seems to be keeping his pain under control. He's even turning into quite the squirmy worm, trying to wiggle his way off his bed (we keep him on his bed outside crate while he isn't mobile, our doc approved this). He's in his crate/pen at nighttime and when we're not right beside him. The vet said this may give him more motivation to use his legs too.
I think the buprenorphine was keeping him pretty sedated so I'm happy to see he's more like his old self. Continuing massage, physical therapy and standing exercises. I will probably start crying tears of joy when he is able to walk again.
[Moderator's Note. Please do not edit
7.3 kg/ 16.09 lbs
Meloxicam stopped on date?
prednisone 2.5mgs 2x/day for 3 days then taper
gabapentin 37.5 mg 2x/day
Baytril (Enrofloxacin) 30 mg 1x/day
famotidine 2.5mgs 1x/day]
Aug 29 at 10:12am:
Thank you. We are stopping the buprenorphine today (last dose due at noon), switching to prednisone and gabapentin. This is what I'm a bit nervous about.
Willow doesn't move much but I will watch out for shivering/trembling, yelping, tight tense tummy, and not eating.
Since the second surgery, the whole time, he:
-cannot move himself other than his head and neck. Some back leg and front leg response but he can't move himself with them.
-hasn't been his perky normal self
-mostly looks around with his eyes but can hold his neck when we do the standing exercises, also looks around using his neck sometimes
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Aug 30, 2019 17:33:25 GMT -7
Jacklyn, what does the neuro say about not being able to vocalize? Was that the case while he was in the hospital or something of recent days?
Glad to hear the adjustment to move to Prednisone/Gabapentin made the difference in keeping pain in control.
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Post by Jaclynn & Willow on Sept 3, 2019 13:10:42 GMT -7
I will ask Dr.Bolliger why he can't vocalize. He hasn't been able to vocalize since the second surgery. He is definitely trying.
I have a follow up appointment with Dr.Bolliger tomorrow (Sept.3)
Willow seems pretty sedated from the gabapentin (37.5 mg 3x/day). We increased to 3x/day because he couldn't calm down at night. Whining/barking with panting for hours. I have asked for a sedative multiple times for night time but none of the vet doctors seem very keen on that idea. Gabapentin 3x/day seems to help but he also sleeps a lot during the day on it.
When I do his physical therapy/range of motion he is either barely able to keep his eyes open, or is doing his barking/whining. So I'm not sure how good his pain control is. I really feel useless in all of this. Hopefully Dr.Bolliger will be able to help tomorrow.
We are still expressing his bladder every 6-8 hours. His post-op instructions say conscious or unconscious voiding should return within 14 days post op but here we are still expressing, 14 days post-op..
I haven't noticed any improvement in his front or back legs. He stretches his back legs out sometimes (rarely) and I haven't seen much movement in the front at all. I think I saw more leg movement when he was only on the buprenorphine instead of this prednisone/gabapentin combo. It's a bit disheartening to still have him so immobile.
Are there any resources for good low calorie snacks for Willow while he is unable to move? I worry that he is going to start getting overweight due to lack of movement. He has gained some weight since he's been home.
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Post by Romy & Frankie on Sept 3, 2019 13:39:49 GMT -7
Gabapentin does cause sedation in some dogs. It is a small price to pay or pain relief. Do you think the barking and whining is to get attention? Barking and whining are not the usual signs of pain we see.
It is disheartening to see our dogs unable to move. All the surgical swelling can take up to two weeks to subside. At two weeks post-op we can just begin to see how the nerves are healing. Willow is still early in the healing process. It can take a long time for neuro function to return. It can take weeks or months. A few dogs have had some neuro function return after a year. .
At his one month post-op checkup Frankie was as paralyzed as he was going into surgery. Surgery did relieve his terrible pain. It took months to recover bowel and bladder control and the ability to walk. I got discouraged too. For quite a while I saw no progess and then, with water therapy, I did see changes.
It is not a good time to put Willow on a diet since his body needs the energy to heal. You can offer low calorie treats like carrots, small cubes of apple, green beans or some frozen broth ice cubes to lick. Then, when his crate rest is over, you can very slowly lower the amount of his food. |
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Post by Jaclynn & Willow on Sept 3, 2019 14:27:32 GMT -7
I think the barking and whining might be for attention. Sometimes he does it while we're giving him attention though! The nighttime barking and whining is probably because he wants to be in our bed with us instead of in his crate. He used to sleep in our bed with us every night prior to this ordeal.
Thank you for your encouraging words.
I am doing all I can to aid in his recovery - standing exercises every 4 hours during day time, passive motion exercises three times a day, massaging his thighs and running a paintbrush over his legs and paws (vet suggested a soft toothbrush and this texture is pretty close). I will ask when we can start water therapy (I think it's likely still too early).
Part of this being so disheartening is that when he went in for surgery he had only lost movement in his front right leg and 50% in the back right leg, and now after the 2 surgeries we don't see much movement in any of his legs or tail. During his last checkup the doctor said he does have feeling in all legs, so we will just have to be patient.
I won't put him on a diet and I'll have to get some apples for him (we already give him carrots which he loves).
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Post by Romy & Frankie on Sept 3, 2019 14:46:09 GMT -7
Since Willow has feeling in all legs that bodes well for his recovery. The next sign to look for is a happy tail wag. If Willow wags his tail in response to happy talk or a treat that is the first stage of recovery that we pet parents can easily recognize. Any wagging around pottying is likely to be just reflex.
Frankie's tail was like a dead weight for a while completely inert and then, one day, a small wag. He just went on from there.
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Post by Jaclynn & Willow on Sept 4, 2019 10:54:04 GMT -7
Well I just got back from Willow's check up with Dr.Bolliger. Dr.Bolliger is keeping Willow for 3 days for intense physical therapy and laser therapy. Willow will come home for the weekend and possibly need to go back for another 3 days next week.
I was very caught off guard by this. I thought this would just be a check up and maybe a med adjustment. Dr.Bolliger isn't satisfied with Willow's progress and says he needs this. I feel lost right now. Our insurance doesn't cover any physical therapy and I don't know how the hospital stay will be billed (we are already looking at over $4000 even with our insurance coverage, the bill before this was over $20k.) We don't have any other options for a second opinion on Vancouver Island, the only other place we could go is Vancouver which involves a 5~ hour trip/ferry ride plus hotel stays.
I thought his recovery would take awhile but I have to trust our surgeon right? He is board certified. I just feel so helpless in all of this, and I am constantly being caught off guard.
Since Willow came home on Aug.24 my partner and I have barely slept. Willow keeps us up through the night almost every night, the past week has been his attempts at barking/whining through the night. I am sleep deprived and just want this to be over and Willow to be recovering at home, and I thought we were at that point.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Sept 4, 2019 11:12:16 GMT -7
Jaclynn, not everyone can afford everything...that's just the plain fact. You need to voice that kind of PT is simply not in your family's budget. There is PT you can do at home. Nerve function will not come back until the nerves have connected. Nerve growth is one millimeter per day. So a twelve inch nerve span damage could require a year or so to grow. Once there is a connection, then you would see some signs of neuro improvement. You would continue to do at home PT to keep the joints flexible and the muscles firing via reflex until Willow's body can take over via brain directed leg movements. 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. Post-op PT for the paralyzed IVDD dog:
Water therapy ideas at home. LInk to page:
www.dodgerslist.com/literature/watertherapy.htm
First find out the costs of each PT your surgeon is suggesting. Then you can see if any part (Laser/or acupuncture, underwater treadmill) fits your budget more down the line when you recovery financially from this HUGE surgery expense, see what makes sense with your budget. DO NOT be talked into spending money on PT you do not have. There is no shame in not going in full blast with expensive PT. Many a dog lives in a rural area with no PT clinic. With at home PT the self healing nerves can have the potential to heal and have the dog walking. We get member who report back to us a year out, their dog ended up walking. Most neuros do not get year updates. No one ever knows the story of when nerves will heal. It is a matter of time and mother nature who will give the answer. It is VERY, early in the nerve healing department. Please stay strong, stay postive and never give up. It makes no sense to put your household in dire financial circumstances that could jeopardise yourselves and the ability to care for Willow at some future point if needed.  |
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Post by Romy & Frankie on Sept 4, 2019 13:24:34 GMT -7
As Paula mentioned surgeons are not always updated on a dog's progress after a time. The last time I saw Frankie's surgeon was at the one-month follow up. At that point there had been no progress at all. I don't think the surgeon knows that Frankie regained his ability to walk and bladder and bowel control. That may be why we sometimes see surgeons be quite pessimistic about recovery chances.
PT at home will help Willow. Professional PT is great for those who can do it, but many people cannot. The extent of Willow's recovery is not dependent on professional PT.
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Post by Jaclynn & Willow on Sept 4, 2019 13:28:43 GMT -7
Thanks Paula. I was expecting to have to pay for some physical therapy and was prepared for that, but I wasn't prepared for this. Dr.Bolliger wasn't able to give me any billing info but said this was essential for Willow. I will deal with this cost for the 3 days, and see if it is necessary for him to go back for another 3 days next week.
I have been doing a lot of the exercises/massage in that first video. Hopefully Willow does well during these 3 days. When I get the follow up phone call I will ask why it is so essential for Willow to get this intensive physical/laser therapy, why isn't he satisfied with Willow's progress when it's so early still.
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Post by Jaclynn & Willow on Oct 19, 2019 13:20:16 GMT -7
Oct 1 graduate  It's been a long time since I updated! Starting the week of Sept 4, Willow spent 2 weeks in a row of a few overnight stays each week at the vet hospital, doing intense physical and laser therapy. After those weeks he came home and I would bring him back for physical and laser therapy 3-4 times per week. As of October 7 until now (October 19), we have been bringing him back once a week. Willow still doesn't have bladder control, but he is regaining a lot of muscle. His muscles had atrophied so badly during his hospital surgical and post op stay, that when you guys kept asking about the sniff and pee test I couldn't even visualize how that could be possible. He was so weak we couldn't even hold him to do a sniff and pee test outside, not able to hold his neck or head up at all, he was a wet noodle. I am at least able to hold him and express his bladder while he is upright. I take him outside anytime it's not pouring rain or dark to do so, but he hasn't initiated peeing on his own yet although he does sniff. He has come a long way since I last posted but we still have a long way to go. I'm happy to report that his neck is MUCH stronger, and he is gaining muscle in his legs. He has sensation in all legs and if we tickle his paws he will occasionally kick. He occasionally wags his tail a little but the happy tail wag isn't back yet. His voice/bark hasn't completely returned but it has come back a little. He occasionally is able to support his back end with his own legs and no support from me, this doesn't last long but I try to practice this with him often (I have to prop him in position for him to do this, he can't get up on his own). I do standing exercises with his front and back ends, as well as with my partner where we both engage his front and back end and then "wiggle" him a bit to engage his core. He still mostly makes raspy noises but there's an occasional quiet whine or tiny bark. His third eyelids are still up but not nearly as much as a few weeks ago. I took him off work for over a month when everything first happened. Now I am back to working full time but come home every day to feed him, express him, and do some stretches and exercises halfway through the work day. My partner and I do exercises with him together before we both leave for work. He has been on gabapentin 50 mg twice daily for quite some time now. Unfortunately he still gives us a lot of trouble through the night, crying and whining, and we are unable to figure out what's wrong (express him, sometimes he poos, sometimes we give him some food, or flip him over, rub his neck). We tried trazodone at bedtime for few nights but that didn't change anything. His muscles are very sore and trembling in his neck and shoulders. We try to massage and stretch these as much as possible. We have recently been trying methocarbamol dosed on his weight (50 mg) twice daily but it doesn't seem to cover his pain throughout the day. We are still waiting to hear back from our pet insurance and vet who have been trying to figure out our billing. It's been months. I don't know how the finances for this are going to turn out and with it taking so long, and rehab visits continuing, this has been a constant source of stress. Glad we had pet insurance, but it really is taking a long time to get sorted out. |
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Post by Romy & Frankie on Oct 19, 2019 14:01:20 GMT -7
We are very happy to have this update. Willow is definitely making progress Being able to stand on his own, even if only for a brief period, is excellent. It shows improvement in muscle strength and balance. I remember doing something similar after my dog Frankie's surgery. We would help him into a proper standing position and he could stand by himself. First for a few seconds, then longer and longer. It sounds as if Willow is having painful muscle spasms that the current dose of methocarbamol is not controlling. It may be possible to increase the dosage. The effective dose that we most commonly see is 125mg every 8 hours. Methocarbamol does not last that long in the body and may have to be given 3x a day to provide relief. Dr Dawn Reuben talks about methocarbamol doages in the article below: She suggests a dosage at 7 to 20 mg per pound (15 to 44 mg/kg) up to three times daily. The dose of methocarbamol should not exceed 150 mg per pound (300 mg/kg) per day. Written by: Dr. Dawn Ruben Last Modified: August 11, 2015 It is important to do your own reading about meds so you can participate in discussions with the vet and be able to advocate on behalf of your dog. Let your vet know that Willow is still having painful muscle spasms and ask if there is room to move up on the dosage. Willow should not be in pain. We are not vets and do not know the specifics of each dog's health. We are making this suggestion based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet. It may be that simply controlling Willow's pain will help him at night, but you can also ask the vet about other sedatives if trazadone is not helping to keep him calm at night. Dogs can react differently to a particular sedative.
Willow is getting stronger. Keep an eye out for a happy tail wag.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Oct 19, 2019 15:52:29 GMT -7
Jaclynn, what does the surgeon feel is causing Willow's pain and muscle spasms? You said his muscles are very sore. It may be that the therapy being given is too intense. Rehab should not cause sore muscles. Willow's strength and stamina need to be very gradually built up and then steadily maintained. Overly intense therapy is not going to bring back neuro function quicker. Therapy helps with joints and muscles but only time heals nerve damage. What type of therapy are they doing for Willow in the hospital?
Do you see any sign other sign of pain at this time?
◻︎shivering-trembling ◻︎yelping when picked up or moved
◻︎slow to move ◻︎tight tense tummy
◻︎arched back, ears pinned back ◻︎ head held high or nose to the ground.
◻︎looks up with just eyes and does not move head and neck easily.
◻︎ not eating due to pain of moving jaw with a neck disc or pain of back disc
Glad to hear of the improvements that you've seen. Nerves are very slow to heal but heal they can!
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If we were in Vancouver we would've had much faster/direct access to MRI but there are none on the island for animals.
Dr.Bolliger says it is muscle loss from laying down for so long.