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Post by Christy & Carly on Jul 20, 2020 13:05:35 GMT -7
Carly weighs 21 lbs and 4 years old. She has been given meds below and started on 7/17/20:
Prednisone 5mg - 1.5 tablet every 24 hours for 3 days. 1 tablet every 24 hr next 3 days. 1/2 tablet every 24 hr for next 3 days. Gabapentin 100mg - 1 capsule every 8 hours Amantadine 100 mg - 1 capsule every 24 hours
[Moderator's Note. Please do not edit 21 lbs Prednisone as of 7/17: 7.5mgs 1x/day for 3 days, then 7/20 test taper for: _pain / _neuro gabapentin 100mgs 3x/day amanatidine 100mgs 1x/day Pepcid AC (famtodine 5mgs 2x/day]
Carly is a brindle dachshund, living in Austin TX. she started with wobbly legs and eventually could not stand or use her back legs by next morning. Diagnosis was T3L3 Myelopathy, no MRI done yet. Surgery was suggested but I wanted to go medical management route first as surgery is too costly. Vet tech quoted approx $6K for surgery and MRI costs.
Emergency vet was seen on 7/17/20 and strict crate rest was started. on 7/20 she looks to be in no pain. She can wag her tail and move her legs, but cannot put too much weight. She also waits to go outside for potty, and sniffs out her spot. She has been eating as normal and drinking water.
I have noticed little bright red blood in her urine, not all the time but sometimes. I did incorporate 5 mg of Pepcid AC every 12 hours. Should I increase that dose?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jul 20, 2020 15:04:55 GMT -7
Welcome Christy, we are glad you have joined us. Can Carly move her legs in a walking motion whether that is a wobbly walk or not? Are you using a sling at potty time to keep her butt from tipping over? Carly can be a good candidate to heal her disc with 100% STRICT Rest and with time be able to self- heal her nerve diminishment. All that depends on your ability to commit to th single most important care during conservative treatment— very limited movement of the vertebrae. Carry your dog to and from the recovery suite to the potty place and then allow a very, very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. ** ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! BLOOD IN URINE With a disc episode incomplete voiding of bladder if it had or has been affect by nerve damage can mean a urinary tract infection has started. What was last date of a urinalysis, recently? Had she every lost bladder control since 7/17?--- that is leaked on you when lifted, found urine leaks in bedding? PEPCID AC 21 lbs dog x 0.44mgs famotidine = 10 mgs Pepcid AC (famotidine) every 12 hrs.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 20, 2020 15:10:12 GMT -7
ROADMAP Avoid dangerous detours with the Conservative Roadmap for your fridge. VIEW, DOWNLOAD and print from here: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdfNOTE: Sample partial preview image of Roadmap is below. Download from link above ** Education is the key to IVDD! Our goal is to help you maneuver things that can be overwhelming with an IVDD diagnosis in caring for your dog. Getting quickly up to speed on intervertebral DISC disease helps you in understanding the why of what your vet advises and the ability to bring things to the table in working together to help heal the disc. You will be very amazed how quickly you can learn a lot about just one disease which a vet is not able to know in great detail for every single disease known to cats, dogs, birds, and many other species they treat.
Keep in mind the key word in the name of the disease is DISC. #1 Take a look so you can visualize just why the need to be strict about crate rest for the DISC is so important in preventing a surgery
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Post by Christy & Carly on Jul 20, 2020 15:10:24 GMT -7
Yes I do use a sling when I take her out. And yes she does move her legs in walking motion while i'm holding her backside with a sling. I try not to let her put any weight on the back legs, but she moves them like she is walking. I have not had a urinalsis done recently. Yes she had leaked urine on the first day back from Vet on 7/17 but i think it's b/c she was in a lot of pain, and I had not given her any medication yet. Also she has always leaked of urine b/c of excitement previous to her injury.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 20, 2020 15:16:08 GMT -7
Blood in the urine is quite often an indicator of a bladder infection. An infection can quickly move up in to the kidneys where it can become life threatening. Call your vet to find out if you bring in a clean catch urine sample or if Carly needs to be transported in so the can obtain an uncontaminated sample.
All vet visits must be carefully weighed for only the most important visits, the things that just can't be taken care of over the phone. Suspect UTI is one of those time transport in to a visit outweighs the risk to the disc of transporting..
Pad out the crate with rolled up blankets. It is to keep her spine/back snug in the crate and from from shifting as you take a corner or come to a stop.
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Post by Christy & Carly on Jul 22, 2020 7:26:17 GMT -7
Update: Paula I called the vet and mentioned I had not seen blood in urine since Sunday. so she stated it could be stress related, and we could wait on a visit. they wanted me to transport her in to get a urine sample, and not an at home test. I'd rather keep her comfy at home, so I'll wait and keep an eye on her potty breaks to see if there's anymore blood. Let me know your thoughts.
Also do dogs develop blood clots or anything related to resting or laying too long? I'm concerned being in crate for much of the day will cause other issues.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Jul 22, 2020 8:14:51 GMT -7
Christy, do keep an eye out on the urine. Some UTIs do not show us humans any outward signs. Other UTIs will show signs of foul odor, change in color, dog dribbles, dog holds urine- doesn't want to pee because it burns.
Dogs have a very acute sense of smell, if you find she is licking genitals, could be that she CAN smell what you can't, a foul odor that things are not right...UTI? The urinalysis confirms the presence or lack of bacteria in urine.
Carly repositioning in crate, going out to potty every 4-6 hours or sooner while on pred, gives her legs opportunity to move and circulate blood. In my years since 2007, I have not read about any members reporting blood clots from doing 100% STRICT rest in the recovery suite.
PREDNISONE TEST for PAIN TAPER I see the taper test started Monday, July 20. Are the pain masking pain meds still on board? Pain meds blindfold you in correctly assessing if there is still existing pain and the need to get back up at the anti-inflammatory dose of Pred asap by reporting your observations to the vet. Which did your vet want at the start of the Pred taper test: --- to back off the gabapentin and amanatidine with less mgs or less often dosing? OR.... --- to do a full stop of both pain meds?
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Post by Christy & Carly on Jul 23, 2020 7:39:33 GMT -7
Hi Paula, so you're saying since I'm tapering the prednisone, I should be tapering the Gapa and Aman? The vet has not suggested any other tapering, so it seems I should probably call.
I called the neurologist office and they indicated all other meds stay the same. Amanatidine is dosed for 7-10 days and will stop after that. Gabapentin will continue for some time, they did not say how long. I did schedule a followup visit next week 7/29 for a checkup with the neurologist. any suggestions I should bring to the doctor? I'm assuming when i'm done with prednisone, I stop the pepcid AC? or should i still continue that?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 23, 2020 7:54:19 GMT -7
Pepcid AC is used to suppress the acids that Prednisone causes. Therefore Pepcid AC is given til off of Pred. Since Carly is under the care of a neuro, you would be following his prescriptions. You, as an integral part of the IVDD health care team, should be knowledgable about any treatment plan. The vet, the neuro, should be cluing you into the reasoning behind all meds in use. If they don't, then do not be hesitant to ask. Maybe there is a good reason, a health reason or ??? to delay in finding out if all the swelling is really gone. Only your vet/neuro knows these things. Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with IVDD. Each of us needs to be self educated so we can team up to work with our vets. "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!" www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdf We are continually learning here at the Forum too. When you are up to speed on your Neuro's reasoning behind his med Rx's, we'd love to understand too.
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Post by Christy & Carly on Jul 28, 2020 13:54:29 GMT -7
I will be taking Carly for a re-check visit tomorrow [7/29]. Carly has been doing very well, she is currently still taking Gabapentin and Amantadine. She is her perky self ready to move around. I've seen her get up on her hind legs wanting to get out of the crate. I've kept her confined to her crate or play pen. What should i expect at the re-check? I hate the circumstances with Covid b/c I will not be allowed in the room with the doctor and Carly. So I will be relayed his review by phone. I've done much reading on Gaba and Amantadine, but i'm still not sure how or when tapering of those drugs should happen. Seems she is comfortable and not showing any signs of pain.
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Post by Romy & Frankie on Jul 28, 2020 14:12:13 GMT -7
I am happy to hear that Carly is doing well. Gabapentin and Amantadine can be stopped at any time although some vets prefer tapering of gabapentin. When the pain meds are stopped and no pain is seen then no more meds are needed. Nobody wants a dog on meds any longer than necessary. But if when the pain meds are stopped, pain is seen we know that there is still swelling in the spinal cord that was not evident because of the pain meds. That means Carly should have more time on the full dose of pred to address the swelling and continue the pain meds.
You could mention stopping the pain meds to your neuro and explain the reasoning behind it. He may not want to stop the pain meds for some medical reason but you have brought your concerns forward.
It is best that she does not jump up, You can cover the top of the crate with a blanket to discourage that behaviour.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jul 28, 2020 15:59:01 GMT -7
If you suspect a urinary bladder infection then getting in for a urinalysis immediately upon suspicion would be a real health benefit so that the infection would not move up into the kidneys where it can become life threatening. That kind of visit would be worth taking a risk of too much movement to the disc. You reported on 8 days ago about seeing blood in the urine. Had you already taken care of that at your local family vet to rule out infection via a urinalysis?
Med change (gabapentin and amantadine) discussion can be taken care of over the phone and would not put Carly's disc at risk as would with a trip in would. What needs to be found out is if all the painful cord swelling is actually gone. What does the vet prefer a full stop or backing off of those two meds that are blindfolding you.
Sounds like there is nerve improvement with the ability to get up on her hind legs with fronts on side of her suite(that behavior needs to be curtailed for the safety of the healing disc). What makes a transport in so valuable you'd risk a potential for neuro diminishment if there were to be too much movement?
I think we may be missing something. So, my question is what is the reason for a risky to the disc trip into the clinic tomorow?
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Post by Christy & Carly on Aug 5, 2020 10:40:55 GMT -7
The neurologist [7/29] was adamant that she see Carly to check her back and leg movement. Of course, as anticipated she squirmed, wet herself, and tried to run off. I was really worried she would injure herself.
But it's been approx 5 days since the visit and she is doing fine. the vet tapered her meds and today is last day off Gabapentin. she has shown no sign of pain. [Moderator's Note. Please do not edit 21 lbs Prednisone as of 7/17: 7.5mgs 1x/day for 3 days, then 7/20 test taper for: _pain / _neuro ]
She actually is getting very restless and trying to walk/stand more. I need to figure out how to keep her busy without movement, any suggestions? the vet said for next time to have a call visit (now that she's seen how anxious Carly gets) in approx 4 weeks to assess next steps and if she'll be ready for rehab.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Aug 5, 2020 12:22:21 GMT -7
Christy, then at this point Carly is off all meds (no prednisone, no gabapentin or amantidine)?
Carly is a lucky girl to not have re-damaged the early healing disc that possibly a phone update on 7/29 about your observations of improved leg function and not being in pain would have worked.. So glad to hear the disc did not suffer any damage. All vet visits need to be questioned for what the exact benefit would be. You can then make a decision what is safest for the healing disc, that others may not be taking into consideration. Remember if there is a set back to the disc it is Carly who'd suffer with pain and having to restart 8 weeks of rest at day 1 again. You maybe would have increased vet bills for more meds possibility if too much relapse of the disc it might very seriously damage the spinal cord with a potential to seriously consider a $5000 + surgery. Dr. Kay: "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!"
In four weeks from today, Carly's disc will have been in the processing of forming scar tissue which should be strong enough to begin introducing her back into family life and activities on Sept 11. So mark your calendar so as to avoid being enticed to short cut the necessary STRICT rest time to give that disc every single opportunity to form secure scar tissue for graduation day of Sept 11.
On Sep 11, you'll best be able to then determine whether money is best spent on say underwater treadmill PT or if there are things you can just do at home. All depends on where she is in neuro improvement on the back legs on Sept 11.
When using the sling, check if you are allowing her back paws to touch the ground. Avoiding hiking up her back end. The idea is to keep the back horizontal to the ground. Using the sling as a bit of backup should she be a bit wobbly, unbalanced. The sling is there to avoid her butt falling over and twisting the back.
MENTAL STIMULATION During recovery time, physical activity must be restricted. Carly can not be allowed expend energy in physical activity to tire herself out. For dogs mental stimulation can be just as tiring. You can help in that department. --- Dr. Becker, DVM, explains "During your dog's mandated rest time for recovery, her movements will be restricted, but her mind will still need stimulation. Teaching her tricks and games appropriate for her temporary physical restrictions will help relieve boredom."
Choose only the activities that can take place inside the recovery suite and activities that do not exceed the demand for 100% STRICT rest for the back. Your dog will be lying on her stomach or maybe quietly sitting. Use your dog's daily food rations as the rewards. Adapt each activity so that it takes place inside of the recovery suite while you sit on the floor in front of the suite's open door. Stop if your dog is getting over excited and displaying rambunctious behavior of too much back movement.
You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when wanting something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second she looks at you, and then give your dog a high-value food reward. [NOTE: for crate resting dogs, shift your body a bit] .... wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give a reward.
lip lick:
head tip:
name object:
Since she does not have a neck disc and if she will calmly use a kong it can help give a job during crate rest.... to work for dinner via a kibble meal frozen into a Kong. Licking and eating will now take more time & effort and it is stimulating. Be sure to subtract what's in the kong from the daily kibble allotment so as not to gain weight.
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Post by Christy & Carly on Aug 5, 2020 12:42:23 GMT -7
Yes, today is last dose from all meds. So how did you calculate Sept 11 date?
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Post by Romy & Frankie on Aug 5, 2020 13:13:18 GMT -7
With conservative treatment 8 weeks of strict crate rest allows for strong scar tissue to form. We always use the analogy of a broken arm. When an arm is broken, the bone is realigned and the cast prevent movement of the area and stabilizes it. With a disc the very strict crate rest is to prevent movement of the spine, allowing strong scar tissue to form.
A broken arm is usually in a cast for six weeks. There is less blood supply to the discs so it takes a bit longer.
Nobody knows exactly how long it takes a disc to heal because there have been no real scientific studies. So here at Dodgerslist we go by vets who are successful in avoiding a relapse by being more conservative on length of time. We also have multiple of thousands of dogs since 2002 when this group was established. We see a pattern of which dogs relapse with an early release from crate rest and better results with 8 weeks of making sure the body formed the disc scar tissue.
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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, 2020 18:12:45 GMT -7
Christy, I had counted 8 weeks from 7/17.
On looking at your first post, I found you had written "Emergency vet was seen on 7/17/20 and strict crate rest was started."
Keep us posted now that all meds have stopped. Fingers crossed there will be no surfacing of pain because all swelling is really gone. All that remains is to get that disc to heal with limited movement.
If you try any of the mental stimulation things, let us know how Carly does with that.... does it help her afterwards to be able to calmly relax in her suite?
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Post by Christy & Carly on Sept 8, 2020 12:05:30 GMT -7
Hi dodger's list team, we are coming up soon on Carly's grad date of 9/11. I have not heard from the Nuerosurgeon, but I may make a call to see what they suggest are next steps. But I also wanted to check in with you to see what I should ask for? Carly is doing very well. she has not shown any pain. she wants to run and play as if she's all back to normal and can use her back legs very well. I have not let her off leash this entire time, still holding her back side with a sling. I did move her to a play pen so she has more room to stretch out and she does move around in her space with no problem. My plan is to do most of the therapy myself, so if you have sites/advice on how to proceed with that, that would be great.
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Post by Romy & Frankie on Sept 8, 2020 13:25:15 GMT -7
Good news, graduation day is soon approaching. Carly is doing very well. Think about how you are going to ease back into more normal activity at graduation. The idea is to gradually give more freedom under controlled conditions. Carly should not have free rein of the house and yard right away. 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. There is a sample schedule to slowly introduce your dog back to family life and physical activity:
Make some home modifications so that you can reduce the stress on the spine in the future. No more stairs, ramps to slide down from furniture: Ramps: dodgerslist.boards.net/thread/867/ramps
Furniture blockers keep our dogs from jumpin on furniture.
After crate rest our dogs can do most of what they have done before. There are only a few things that should change. These are the things to avoid going forward: No more stairs or steps. Use ramps indoors No more jumping up or down, those activities increase impact on the spine. No tug-o-war, pulling games. No shaking toys. No zig zag running. No rambunctious playing with other dogs. No sitting up or standing on back legs. Teach your dog to sit down rather than jump AND keep all four feet on the ground
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 8, 2020 16:56:45 GMT -7
Christy, good work on seeing Carly through to 9/11 which ensures the disc has healed to allow gradual introduction back to family life and physical activity.
Where do you observer Carly now regarding he use of the back legs? -- Does she attempt to scratch an ear? -- Can she move all the way up in to a stand position by herself with back legs? -- When in the sling do you see she makes an attempt to move the legs in a walking motion? -- Can she walk with all fours even if the back legs might be wobbly using the sling only as a back should she tip over?
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Post by Christy & Carly on Sept 11, 2020 11:15:22 GMT -7
Hi Paula, thanks for the reply....here's my answers. -- Yes she has been using both her legs to scratch for some time now. -- Yes she can move to a stand position by herself. -- Yes she moves both legs while in the sling. -- Yes she can walk alone on all fours, she does very well on rugs. you can see the wobbly walk on hard floor.
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Post by Romy & Frankie on Sept 11, 2020 13:08:09 GMT -7
Carly is doing very well. After my dog's surgery when he could walk but would slip on the wood floors, I got several inexpensive carpet runners and put them where he would usually walk. That made it easier for him to get around.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 11, 2020 17:50:56 GMT -7
Thank you for providing a good picture of where Carly is neurologically. I agree with Romy how well she is doing from 8 weeks ago when she could not walk on her own! Good job in caring for her to get the disc to heal! Good job on reaching graduation day!!! One of the links Romy gave to begin a slow re-introduction back to family life and physical activity provides a sample schedule you might follow dodgerslist.com/2020/06/15/back-friendly/For Carly, walking can be the PT. Other at home PT ideas: --- Buy cheap cut of meat or chicken when on sale as really high value treats. Cook, cut into tiny treats and freeze to use as needed each day. --- Do all PT where there are no other distractions of kids or other dogs. --- Do PT slowly so that steps are deliberate- helps to re-train the nerves and muscles to work together in a more normal gait pattern. --- Surface with good traction such as carpet or use of a Yoga mat or rug runners ---reward always for walking and never ever when dragging. --- Do therapy at meal times. Feed dinner a few kibbles at a time, for stands, sits. Scatter some kibbles on a non-slippery floor and use sling if wobbly walking to get his food. --- reward for pushing up from a sit to a stand. ---Use sticks, broom, pvc pipes spaced out on good traction carpet. Dog then will learn to lift paws as they walk SLOWLY over each one.
--- Single leg balance for the weaker leg. While standing, lift the stronger leg off the ground for a few seconds-this will force bearing weight on the weaker leg. Lower and repeat with the opposite side leg. --- Outdoors on leash/harness and if needed a sling. Walk across a gentle slope, walk up and down the slope. Walk on different textures...low grass, higher grass, on sand. ---If it is still warm where you live, it can be walking in a child's $10 wading pool. Start with water at her armpits. As you lower the water level every couple of days it becomes more of a challenge to walk for Carly... good exercise. More on at home water therapy: dodgerslist.com/2020/05/28/surgery-dog-water-therapy/Please do keep us posted on how Carly is getting used to being back to some family activities and strengthening muscles and re-learning muscle/nerve coordination in walking. Which ideas did you choose for blocking furniture? Are you needing to retrain her to keep all four paws on the floor? Ramp training?
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