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Post by Cassandra & Merlin on Mar 19, 2020 8:10:48 GMT -7
Hello, Surgery Saturday 3/14/20. Merlin, mini doxie, 10lbs (lean, very healthy weight). herniated disc T10-T11. Pred 5mg 1/2 tab twice daily. Tramadol 50mg 1/2 tab three times daily. Gabapentin 100 mg 1 cap twice daily (will start tomorrow). Will also start Pepcid (having a hard time finding/ordering it currently). My vet recommended Omeprazole instead. Would you agree? Merlin had his first bout of IVDD symptoms back in December 2019. I immediately took him to my primary vet. We put him on strict crate rest and scheduled with the "amazing" Dr. Ko (I guess one of only 7 doubled board certified neurologist and neurology surgeons in the world). At the time Merlin was considered a very mild case. Dr. Ko did not believe surgery was necessary at that time. He did inform me to go very slowly with coming off of crate rest, also that dachshunds are basically "ticking time bombs" and it will most likely only be a matter of time (he was definitely right). Unfortueatly Dr. Ko was not in the office Friday 3/13/20 and not on call that weekend. So I took Merlin to a local Orthopedic Specialist. Merlin began the "drunken sailor walking" Friday around 1pm. The Orthopedist kept him over night and by Saturday morning Merlin had declined and was not able to walk, so surgery was preformed. He is currently doing well considering. I took the advice given by dodger list on the crate set up. He has a catheter in and will have it removed on our follow up appointment Monday 3/23/20. He has had 2 bowel movements. His pain level seems to be controlled. He is eating and drinking well. I apologize if I forgot something, I am personally going through cancer treatment and my chemo brain sometimes gets the best of me thanks for your understanding. Thanks, Cassandra  |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 19, 2020 10:53:35 GMT -7
Cassandra, welcome to the Forum, we are glad you are here. You do have a lot on your plate regarding Merlin's and your health issue. Normally a dog comes home with having had a hands-on-top of your-hands type of demo from the surgeon on expressing the bladder. Expressing video and tips on BOTH for the bladder and for poop: www.dodgerslist.com/literature/Expressing.htmHow to decide omeprazole vs. Pepcid AC --- Omeprazole takes 3-5 days to become effective, so not the best choice. --- Pepcid Ac becomes effective in 30 minutes. --- If he was on omeprazole since the surgery, then continue with it. --- If you are just starting to protect the GI tract from acids, then you would choose Pepcid AC for getting on the job in 30 minutes. If there is any pain, advocate that any of the pain meds be given 3x/day (every 8 hours) because these meds do not stay long in the body at sufficient level below every 8 hrs. —Methocarbamol works on the pain of muscle spasms. — Tramadol is the general pain reliever. — Gabapentin works on nerve 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 ◻︎ 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 -What date did Merlin come home?
-What was the reason to use a cath instead of expressing, your health issue or another reason?
-Let us know that for sure all pain is in control dose to dose of the two pain meds (tramadol and gabapentin.
-Why is gabapentin just starting tomorrow and not today? Waiting on the compounded form or ?
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Post by Cassandra & Merlin on Mar 19, 2020 14:27:23 GMT -7
Paula,
Thank you for all the information. Merlin came home the evening of Monday 3/16 (after my long day of chemo). The Cath was in when we picked him up. We picked him up about 15 min prior to closing. I was a little disappointed the doctor was not there to go over discharge instructions, only the front desk staff. After all this is a major surgery, not like a simple neuter. But anyways they only gave me Tramadol and Pred. My primary care vet watched him for my 2 short days of chemo on 3/17 & 3/18. I spoke with her about the Gaba and the Pepcid. That's why the delay on the Gaba. I did start him on it today. I thought I had Pepcid at home but I don't, I do have the omeprazole though. He sneezes every time he sits up lifts his head. I put a call into the vet but we are currently having a blizzard here in CO so I'm not sure if I will hear back today. I will also text my Vet. He is slow to move and seems to prefer laying on one side. Im trying to switch his position, not to often, just figured laying on one side isn't the best. Thank you for this wonderful sight! I have been reading and learning so much.
Thanks,
Cassandra
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Post by Romy & Frankie on Mar 19, 2020 15:13:25 GMT -7
You can give him Prilosec until you have had a chance to get the Pepcid. Prilosec is a good stomach protector but it doesn't work as quickly.
When the cath is removed Monday Merlin will likely need to be expressed. It is important to do this because stale urine in the bladder can quickly lead to a urinary tract infection. Ask the vet to give you a hands-on lesson in expressing. Expressing is a skill and must be practiced to be learned. You will know you are doing it right when you get a steady stream and there is no wet bedding or leaking when lifted. Have you had a chance to review this video?
As Merlin heals, his bladder control may start to return. The way we know a dog has bladder control is through the "Sniff and Pee" test. Carry Merlin to a previous pee spot, let him sniff. If he urinates right after, that shows a message has been able to travel from the brain to the bladder. Bladder control has returned!
Is Merlin able to reposition himself in the crate? If not, it may be necessary to move him to avoid pressure sores. If he can move himself this should not be necessary.
Other than slow to move, is Merlin showing any other signs of pain? I am putting the signs of pain here for your easy reference; ☐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. If you are seeing any other sign of pain, let your vet know what you are seeing. Merlin may need his medication adjusted.
I hope that your remaining chemo sessions go well.
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Post by Cassandra & Merlin on Mar 22, 2020 13:27:40 GMT -7
Thank you for the info and the video. I have a follow up with the vet tomorrow 3/23. I will be sure to talk to him about expressing. Merlin seems to be doing well. Although today he did manage to get his urinary catheter out. 🤦🏼♀️ I went into the kitchen for a few minutes came back and he must have got it wrapped around his legs. His cone has been on. I wish it didn’t come out that way but maybe now that it’s out, it’s for the best. I call the vet and they said as long as he is able to urinate he should ok. He is having a bowel movement once a day and seems to notice/feel when he needs to go. He is able to rotate himself well. I still make sure he is switching sides to prevent sores.
Since adding the Gabapentin his pain seems much more controlled. I was curious what your thoughts were in terms of his weight. He wasn’t eating much after surgery for a few days (about half). Because he was lean to begin with he is now on the “to thin side”. I increased his food a little. I’m assuming a lot of it is also muscle wasting. Should I not be to concerned about this just yet?
I am new to this board/thread situation, please if I’m doing something wrong just let me know.
Thanks,
Cassandra & Merlin
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Mar 22, 2020 13:41:49 GMT -7
Cassandra, thank you for the update. You know, I would now take him outdoor when you know he should have to pee. While on pred he'd be more thirsty and drinking more water, so maybe a bit sooner to give him a chance to pee outside. Let us know if he passes the "sniff and pee" test as follows: The only way for humans to know if there is truly bladder control is with the “sniff and pee test.” Passing the test mean you would not need to manually express the bladder. It helps you to discern whether reflexes are releasing urine or if truly the brain is able to send a message to the bladder. Carry Merlin outdoors, set him 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 in effect kinda expressing the bladder. See if he will release urine on the old urine area. If urine comes out after sniffing, bladder control is returning. Let us know what you observe. An overflowing bladder due to reflexes is not good (finding urine in bedding, leaking on you when lifted). As reflex can't void all urine and the part remaining in the bladder can quickly develop into a urinary tract infection. IF no bladder control then your vet will give you a hands on hand lesson at tomorrow appt. You can get more out of the lesson by first reviewing the video and tip. www.dodgerslist.com/literature/Expressing.htm NOTE: See how to express bowels/poop if he does not have control to wait til outdoors yet. WEIGHT I would add a bit more kibble to gradually over a couple of months time to gain his more normal weight back. Muscle atrophy can happen but usually not just in a couple of days. When there is no nerve signals to the muscles, muscles atrophy.. After his crate rest is over and he is introduced back to family life and your continuing PT with him his muscles should begin to bulk up as nerves at some point begin to self heal.' |
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Post by Cassandra & Merlin on Apr 8, 2020 15:05:17 GMT -7
Hello,
I just wanted to let you know Merlin is doing well! He was seen by the vet last week (4/1/2) and had his staples removed. We started PT and Merlin is responding well. Unfortunately due to the virus we have to do everything from home, so no underwater treadmill but we are using the tub and having him walk. He is able to stand well, go to the bathroom when taken outside and is starting to walk more and more. His pain seems to be managed well. I just wanted to say thank you for this site and for your guidance. It's scary when they go down, no matter how prepared you think you are!
Thanks,
Cassandra & Merlin
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 8, 2020 19:49:21 GMT -7
Cassandra. wonderful he has bladder control! A lot of surgeons want either 4 or 6 weeks of crate rest. What did your surgeon want? If 4 weeks then graduation day would be April 11. Is he now off of all meds? Lots of ideas for a slow graduation introduction back into family life and safe physical activity: www.dodgerslist.com/literature/AfterCrateRest.htm |
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Post by Cassandra & Merlin on Apr 30, 2020 18:49:28 GMT -7
Hello,
Sorry it's been a while since I have last checked in. Ive been dealing with my own health issues.
Merlin has been doing great, almost back to normal.
As of Sunday 4/26/20 he's been slowly regressing. I took him to see his surgeon on Wednesday 4/29. The vet said he was fine and that I needed to step back a bit on his freedom but keep up with the walking. The vet also put him on
Carprofen 25mg 1/2 tab twice daily for pain. Tonight 4/30, he cried out twice on his potty grass in his pen and then threw up. A little later I took Merlin on the rug in the living room floor, he immediately went inside his pineapple (soft house/bed), I reached in and gently pet his back and he immediately cried out. Obviously something is going on. I know this sounds bad but I am tempted to contact the Neurology specialist tomorrow and get his thoughts and opinions. Although I'm not sure he will be able to help since he did not perform the surgery. Thoughts? I also feel like the spot where the surgery was on his spine feel slightly warm to the touch. Any help would be greatly appreciated.
Thanks,
Cassandra & Merlin
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Apr 30, 2020 21:03:20 GMT -7
Cassandra, without a vet to examine and tell us his diagnosis, I believe until that happens CRATE Merlin. This would be acting upon a suspicion of a disc episode. With a vet to examine him that suspicion might be set aside to muscle pain from over doing things.
So protect his disc for now by STRICT rest. Carry to and from the potty place, no walking around., Eats in the crate. A newly damaged disc could really tear and do more spinal cord damage. So best to act in a safe manner by crating.
Let us know what the examining vet assesses, even a new 2nd opinion vet would not be a bad idea. What issue is this that has so much associated pain?
Do you have Pepcid Ac on board with that carprofen? 5mgs twice a day
Hope you are managing your own treatment with success.
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Post by Cassandra & Merlin on May 1, 2020 18:28:13 GMT -7
Hello,
Merlin's surgeon (vet that did his surgery) did take a look at him. The vet thinks he just over did it, so muscle pain. Only if it Merlin continues to regress he said, possibly they were not able to get everything out/or fixed properly (sorry I wasn't exactly sure what he said). They do not have MRI access at the orthopedic place where Merlin had surgery. So this makes me a bit nervous. I feel like with the spine and nerve issues it makes a huge difference having an MRI vs CT. Thoughts? I could take Merlin to Dr. Ko the neurology specialist and have him take a look and talk about having an MRI done. Thoughts on this? I am giving him the ✙Pepcid twice a day.
[Moderator's Note. Please do not edit
Carprofen as of 4/26: 25mg 1/2 tab twice daily for pain.
✙Pepcid AC 5mgs 2x/day]
Thanks,
Cassandra & Merlin
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on May 1, 2020 21:13:00 GMT -7
A CT should provide the necessary information to aid the surgeon in planning of the surgery. Just like any diagnostic test (such as CT, myelogram) an MRI is not able to provide a diagnosis 100% of the time. Nothing to make you nervous about by using a CT for planning the surgery.
There are times when a surgery is just not able to get all the disc material removed from where it is not supposed to be. Other uncommon times some small piece of disc material may have been quite well hidden and missed. There have been a few cases over the years where a 2nd surgery was needed...again this is not a common thing.
If Merlin should regress, if it ups your confidence to have a 2nd opinion with Dr. Ko then, there is no shame at all in going for another opinion.
Hope to hear back from you, that Merlin had overdone things and feels a lot better as would be the case if muscle strain.
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