Michelle's Max 1/17 conserv - G. Shepherd; GRAD 3/13

Michelle, welcome to the Forum. We are glad you are here. Conservative treatment  of STRICT in the crate is for the disc to heal. It looks like strict rest to allow the disc to heal ended on about the 6th week with the begin of underwater treadmill.

I think we have a difference in terms that can be confusiing to both of us.

Conservative treatment is ONLY for the period of time it take the disc to heal.
    - Disc healing require STRICT crate rest so that strong scar tissue can form.
    -  During the period of crate rest prednisone is used to resolve all swelling.  Pain meds are use to give comfort while Pred may be at work somewhere in the range of 7-30 days.  
    Normally a dog is not released from STRICT rest, until off all meds and pain shows.

QUESTION
Would clarify more about prednisone.
      -- Did the vet try several times to go off of pred but the pain would still surface?
     --  Could that be the reason he has Max on the lowest dose of Pred that gives him relief from pain?    

Once the disc has been allowed to heal, conservative treatment is over.

What comes next when the disc has healed and it is safe to resume activity, things like the underwater treadmills can work on helping Max to learn how to coordinate his brain with the muscles in his leg.   Max' body can do even more self healing of nerves. Many humans have a tough time with patience to let the slowest departement of the body to heal---the nerves.  It is better to think in terms of months rather than days/weeks for nerve healing.

You have Max in the very best kind of post-conservative treatment with the therapy of under water treadmill. With time he will very likely improve the right back paw from knuckling under as well! 

Nerves heal typically in the reverse order of the damage to the spinal cord. Look where Max is currently in a rather short time since Jan 17th.
1. YES!  Deep Pain Sensation (Only correctly identified by a specialist.)
2. never returned post-op  Tail wagging with joy at seeing you or getting a treat or meal.
3. YES! Bladder and bowel control verified with the "sniff and pee" test.
4. YES! Left Leg Movement, and then _?_ability to move up into a standing position,
     and then YES! wobbly walking left leg.   YES! not knuckling paw under
4a.  Not yet Right Leg Movement, and then _?_ability to move up into a standing position, and then _?_wobbly walking.  _?__not knuckling paw under   
5.    Being able to walk with more steadiness and properly place the feet all the time
6.    Ability to walk unassisted and perhaps even run.
More info: www.dodgerslist.com/literature/healingnerves.htm

It would be a good idea to get a sense of how long it takes for nerve healing. After all you want to be in the know to feel confident that Max will get back to enjoying life again. Lots of success stories to look at: www.dodgerslist.com/monthstory.htm   


Max looks up to you to know things are right with his world...he studies your body language, your smell, your look.  Remember to put a big smile on your face and in your voice and carry it in your heart while your dog is healing his nerves and working really hard at the underwater treadmill! Dogs CAN smell when you are happy, sad or scared because each emotion has a subtle change in your scent. Many times their behavior reflects our mood and they may even misinterpret our sadness and tears and believe they have done something wrong. Everyone heals better in a positive energy environment. SO,  "put on a happy face!!" It will help you and your sweet one!!

Also besure to take care of yourself. Go ahead and enjoy a night out so you  come back the next day happy and refreshed to spur Max on and lift his spirits.  When you feel things going out of control take a deep breath!
   Your dog will pick up on your stresses and internalize them...not good for your recovering patient! This simple breathing technique can help YOU help your dog:

Michelle, you can learn how prednisone is used by vets who know IVDD during a disc episode here: www.dodgerslist.com/literature/healingsweling.htm   I do not really understand your vet's treatment.  
    Likely because of his age the disc could have been a naturally aged disc deterioration. The Neuro surgeon Dodgerslist consults with says anytime there is nerve damage, the dog should follow the principals of STRICT rest that is the hallmark treatment of conservative treatment...even if that deteriorated disc is due to a Hansens II type of disc damage.

At this point in time, it appears the neuro damage did not further deteriorate and Max lucked out.

While on the big gun prednisone (which thins blood), it would be best to NOT also give tumeric.

PEPCID AC (famotidine)
marvistavet.com/famotidine.pml  

Have you specifically done some happy talk to Max?  Or maybe an extra yummy treat coming might cause him to attemp tto do a happy tail wag.   At any rate his neuro functions have well passed the neuro function of a happy tail wag and he IS already down the list to that of  moving one back leg and placing the paw correctly!!

For the one right leg that is not as far long with nerve healing, are you doing some massage and PT at home as well as the under water treadmill?

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.

Michelle, deep pain sensation (DPS) is the ability to perceive a noxious stimulation when applied to the tail or toes.      DPS indicates there is still an intact nerve pathway to the brain. 
 Thus the potential for nerves to heal and at some point in time nerve functions to come back.  
     There is no person who would be able to give you a timeline or date for nerve functions to return.  How fast nerve function comes back is due to many of variables (things like:  each dog's body's ability, how much nerve damage happened at that particular disc episode, the distance from brain to the nerve damage location and other complexities to numerous to mention.)
     The rate of axonal regeneration has been assumed to be constant and, in clinical situations, is generally estimated to be 1 mm per day. So a 12 inch span of nerve damage would take 1 year or so to self repair to bring back a function. HOWEVER.... reported rates of regeneration vary broadly from 0.5 to 9 mm per day.   See why it is impossible to predict the timeline of when things will happen with nerve repair?

         The only thing anyone can tell you is in general the typical order of return.   NOTE: "in general" covers the fact that in some few cases  bladder control may return but not tail wagging.   Bladder control would return but not bowel (anal) control.  You can scroll back up to see that predictable order of nerve function returns in.

Michelle, please take to heart the nerve healing philosophy of Veterinary surgeon Andy Torrington BVMS CertSAO MRCVS:

Good news that Max is showing improvement after each session. My dog Frankie did very well with the underwater treadmill also. When he started he was paralyzed, unable to stand let alone walk. The buoyancy of the water helped Frankie stay upright in the tank. The therapist knelt behind him helped him move his legs in a walking rhythm and positioned h is feet. Each session I saw some improvement. Frankie regained his ability to walk. I don't think this would have happened nearly as quickly without this form of therapy.
We would love to see pictures or videos of Max. Here is how to post pictures on the Forum. When you are editing or composing a post, there is a button on the top right side that says add image to post. From there you will have the option to browse your computer for the photo or drag and drop. This does not work with Quick Reply
—First upload your video to YouTube.com
—At the top of your browser when viewing your uploaded video you will see a "share" button below your video window.
— Pressing it will expand to reveal the URL (it starts with <http...> ) you can paste URL into a Forum post.
—How to details for mobile devices and computers:
support.google.com/youtube/answer/57407

He went 2x a week for about two months.  The first time I brought him it was with a sling.  His back end was a dead weight.  The last time, he trotted out by himself.  During this time he also regained bowel and bladder control.

Hi Romy,

I feel so happy for you!! Frankie is awesome! Frankie only took 2 months, that is amazing! Max had 6 sessions of underwater treadmill already (twice a week so 3 weeks now), I’m finger crossed that Max could do what Frankie did!

Hi Julie,

Thank you for your comfort and kind words. I did learned a lot and am so thankful that I found here and have you guys around to help me and encourage me. I will update Max’s progress whenever I can .

I have been reading many posts here and get so inspired and touched. I love those successful stories! By the meantime, I do have a big concern: Max has not wagged his tail yet. When I take him outside potty, he can lift his tail and then poop. When I tickle his hind feet, his tail suddenly squeezed. I think those are just reflexes. Max has bladder control and control for bowel movement but where is the tail wagging? (I always do happy talk with Max) Will I ever see the tail wagging?

I don’t remember if I mentioned that when Max was in the underwater treadmill he was lifted in the back end by the therapist to assist him walking. According to others’ posts, tail wagging is a critical indicator? So confused, please help! Thank you everyone!

Thank you Marjorie! I feel like a new student that have to learn everything about IVDD and the symptoms from the beginning. I feel so lucky that I found here for great advices and knowledge. Thank you so much!

This morning I woke up at 7:30am and I was going to put the harness on Max to lift him outside to potty. What I found was:

1. Max saw me and immediately sat up from a lying down position and then CRAWLED toward the water bowl which is about 7 feet away. His hind feet were both under him and he did not drag.

2. Before Max reached the water bowl to drink I found the tile floor was already wet which mean he must have been drinking at night, cause I cleaned the floor dry before I went to bed. And when I found him he was in his bed, so that means he managed to drink and then went back to bed by himself, could be crawling or dragging who knows, but he was in bed when I greeted him this morning.

These were what I found this morning I don’t know if those are good signs or nothing at all. When I lift him into his bed I can clearly see his LH foot will lift up and stepping onto the bed, today I saw the RH foot did that once too. I started the PT at home and I can see very strong reflexes on both his hind limbs when I tickle or massage.

I’m still very sad that no wagging tail but I understand after the surgery he did in 2017 I just didn’t see much wagging, maybe occasionally? I’m in Southern California and the rainy days here lately really make my mood cloudy. Other than tail wagging, what is the next scene or indicator that I should expect to see from Max? He is always very bright and alert, always energetic and happy. Eat crazily like I starved him for ages, drinks a lot with that loud funny sound. Sometimes I wonder, other than his hind legs not working, I think he is more healthy than me. ;-)

I just want to share some pictures of Max. 

   

Is there any recommendation for hot spot treatment? I found one sore on Max’s right back leg, the location is at the back of the leg. I first thought it could be bedsore but I have a second thought:

Max can change his position by himself, I see he flips over to switch sides when he is sleeping. During the daytime, I also see he changes sitting position by himself. So I don’t think it’s bedsore now.

Because of the twice a week underwater treadmill, and sometimes he was not dried thoroughly so I suspected it could be hot spot because the wetness tracked underneath his thick coat.

I see the spot is very round and red raw, no discharge or odor. Has hair loss. I used Animax ointment on the wound, I got the ointment from my regular vet before and I remembered she said it could be for hot spot. Other than this ointment, is there anything else I could use to help Max? Please help, thank you so much!

Thank you Marjorie! According to the hot spot location, Max is not able to reach it to chew or bite which is a relief to know. I started to use the Animax ointment on Max yesterday for 2 times and this morning I can see the hot spot is not as red and raw but turned into pink skin color and the swelling seems also calmed down. I kept using Animax on him and made an appointment to see his regular vet tomorrow just to be sure and safe. Finger crossed this is nothing serious just hot spot. Just wonder can Max still go to underwater treadmill with Animax ointment on him?

Thanks Julie, I will take Max to see his vet tomorrow morning. I sent the wound pictures to the vet and she confirmed it looks like hot spot and she recommended Animax ointment [nystatin, neomycin sulfate, thiostrepton and triamcinolone acetonide corticosteroid]. But I still want to take Max in to let her see and also go over with her for some general questions. I do whatever it takes for Max :-)

Thank you Judy! I know I need to be more patient which is the hardest lesson in my life to learn :-( I am never a patient person not even to my own child. I guess Max is trying to teach me being patient in his way :-)

Updates back from the vet today 3/17

The vet checked on Max’s wound with flashlight and confirmed it is hot spot. After her explanation, I knew this is my fault. This typical hot spot Max has is due to moisture under the thick coat plus rubbing by the harness to cause the skin irritation. Max does twice a week underwater treadmill and they didn’t dry him thoroughly and I didn’t do it either when Max is back home. So this explains why Max has this hot spot. My bad, I feel ashamed.

The vet clipped the hair around the sore and gave me more Animax ointment to use ( 2 times a day until it clears up, hopefully by Friday the vet said) I also let them to trimmed Max’s nails there. Everything went smoothly.

I will definitely dry Max well after each underwater treadmill session and keep an eye on the wound. The vet said it is fine to go to the hydrotherapy with the hot spot as long as l clean it and dry it afterwards.

Updates for today 3/18 :

Took Max to the rehab center, acupuncturist/therapist checked his hotspot and allowed him to proceed the underwater treadmill. However, the therapist said there was minimal movement in both hind limbs, which I don’t understand cause in the past few days I have seen clearly Max has steps on LH foot and some on RH foot. I asked the therapist and she said dogs could have good days and bad days like human. She could not explain why either, maybe because of the hotspot? Anyway, I don’t get it.

The good news today is Max can feel one point on each hind foot by the acupuncture needle. The acupuncturist said this is a good thing.

I’m super exhausted and also sad that I thought for sure Max could do well in the underwater treadmill but he didn’t. I even saw the steps he made while with the harness assistance. I also worried about the rehab center might close down because of the virus. Daughter’s school already closed now. Too much stress and I’m crying...

Hi Julie,

Thank you for the warm words! I really need them!

I already asked the rehab center, they said they have no plan to close down however if the county requests then they have to.

I just checked Max’s hotspot and it looks way better now, I keep him dry after the hydrotherapy and take off the wet harness to let it dry too. Today is the last day for prednisone 10mg for Max. He finally tapered off it. Now he is only on Amantadine 200mg daily which is going to be ongoing.

I hope Max can do better on Friday’s rehab session. I will try to get myself together and not thinking about the crisis we are facing. If the rehab center does close I have to do PT at home for Max and keep in touch with his regular vet. I feel ashamed that I’m such a whiner and easily overwhelmed...