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Post by Elisa & Augie on Aug 3, 2020 13:00:17 GMT -7
Augie - 2.5 weeks post surgery: normal progress?
Augie - Wire-haired dachshund; almost 5 y.o. and weighs about 11.5-12lbs.
Augie had emergency surgery at UC Davis on Friday, July 17th - he had a chronic and acute herniation at the T13-L1 and L1-L2 vertebrae. He started showing signs of extreme discomfort (crying) on the 15th, vet put him on steroids, anti-inflammatory and pain meds; the 16th was a bit wobbly; the 17th he could not stand, but still had DPS in both back legs and superficial pain sensation in one leg.
Augie is now on strict crate rest for 6-8 weeks (he has a follow up in a few weeks) only going outside to potty 3-4x /day. Limited movement in his crate (can turn around, stand up). I do massage a few times a day and try and do some general leg / walking PT (moving his legs in the motion of a step) when we are out to potty - if he tolerates it. He is not particularly interested in that.
He still seems a bit uncomfortable - he yelped a bit yesterday but that is the first time he has cried since I brought him home. He grunts a bit when I pick him up, too. He is only on gabapentin 2x/day (100mg) and 2.5mg of Pecid 1x/day (he has some other gastro issues and got sick when he was given Rimadyl post-op). He seems to have good days and bad days - he will be super quiet and not hardly move some days; other days be turns in his crate a lot.
[Moderator's Note. Please do not edit
11.5-12lbs
7/15-17 steroids
7/22 post op at home Rimadyl stopped
gabapentin 100 mgs 2x/day
Pepcid AC (famotidine) 2.5mgs 1x/day
When I brought him home (7/22) he could barely stand up but was 'walking' - he seems a bit stronger now, but still wobbly and uncoordinated. He doesn't have superficial feeling in his toes (still rolls them a bit) and can walk fairly well in a straight line - turning seems to be a bit of a challenge as (a) I don't think he has great feeling in his back end and (b) I am not sure he knows where his legs are. He can wag his tail, but he isn't doing that much - I think he may be uncomfortable and/or feel strange (maybe some tingling/numbness) and perhaps a bit depressed. He loves to be out barking and chasing things (he is a dachshund after all).
His potty habits are good - when I first brought him home he could pee on his own, but had accidents if he had too much to drink and I didn't take him out. We haven't had an accident in over a week - even after going longer than usual between potty breaks. He is eating okay - some days he eats everything, some days he grazes/eats part. Poops are okay - perhaps a bit soft the last couple days, but I am trying to reintroduce his normal kibble (he's been on rice, chicken and pumpkin), so he may be having a bit of a reaction to that.
I went through this 10 years ago with another dachshund, but he didn't go 'down' - just was dragging his toes. His recovery was pretty quick and so I am just not sure if what I going through with Augie is normal, that he is healing okay, that he is not in pain, that he isn't getting worse.... It would be so much easier if they could just tell you what was wrong and how they were feeling!! He is my baby so I am just so worried about him! It just seems like he isn't progressing very quickly - am I freaking out over nothing? I know this is a marathon, but a sprint, but I just worry.
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Mary & Mila
Helpful Member 
FEMALE— DACHSHUND
Posts: 218 
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Post by Mary & Mila on Aug 3, 2020 14:44:09 GMT -7
hi there, My name is Mary, welcome to Dodgerslist. Thanks for joining us. What's your name.? Sorry to hear about Augie, glad to hear the surgery is over and the healing has begun. Tail wagging is a very good sign all is healing well and being good with the potty control is another positive, these are all indications that Augie is healing. 2.5 weeks is extremely early post op.
Here are some thoughts from Dr Issacs, one of our Neuro surgeons:"Post-operatively, I will advise owners that I do not get concerned or discouraged until 2-4 weeks postoperatively. The status at 2-4 weeks sets the tone for the dog’s recovery. At 2-4 weeks post-operatively, I hope to have seen some (but not complete) improvement. Sometimes the degree of improvement is dramatic and other times, only very mild. Regardless, as long as some improvement has occurred, I am not concerned/discouraged. Before 2-4 weeks there has not been enough time for the spinal cord to heal, and we have not allowed enough time to pass to see the benefit of surgery. Even if no improvement is noted by 4 weeks, it is not hopeless, it is just not as likely. I also advise that at 2-4 weeks, we are not seeing the end result of the healing process – this typically does not occur for 6-12 months and in some cases, even longer" dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/Crate restHere are some tips for setting up crate rest for Augie, crate rest is just as important for a post op dog as it is for a dog being treated conservatively. When you say he loves to be out running and chasing are you speaking about now or before? For now he would need rest and recovery except for potty and PT. Sounds like you are doing well with the PT Healing takes time
Every dog is different, in the time it takes to heal - there is no time limit on nerve healing dodgerslist.com/2020/04/22/healing-nerves/dodgerslist.com/2020/05/14/strict-rest-recovery-process/The site of the op would still be very tender and possibly sore for him, be sure when you pick him you are supporting his back properly, this is important. dodgerslist.com/2020/05/27/surgery-dog-pt/Water therapy is also very good to strengthen up the muscles and improve coordination again. dodgerslist.com/2020/05/28/surgery-dog-water-therapyIt's understandable to want Augie to heal and get back to normal asap, he will, it just may take time, it is still very early days, take this time to read all you can on Dodgerslist and be the best carer you can for Augie, you will both get there. However if you are really concerned that Augie seems in pain, as you say he has good days and bad days it would be a good idea to call the vet, explain what you are seeing and maybe they will recommend increasing his pain meds. One of our other moderators will best advise you on this also, so do check back later. Please keep us updated on his progress. kind regards Mary |
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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 3, 2020 17:09:06 GMT -7
Elisa, welcome to the Forum. Agree with Mary it would be a very good idea to give feed back to the vet about the pain you are seeing.
Don't have any patience at all with pain. Usually it takes about 2 weeks for all the painful surgery caused swelling to go down.
With the anti-inflammatory Rimadyl needing to be stopped, Augie's inflamed tissues may not have healed as fast. So call your vet or the neuro to report pain.
For full round the clock coverage to keep the meds at a good level, that most often takes dosing promptly every 8 hrs. So advocate for gabapentin (for nerve pain) at every 8 hrs. Discuss getting on board tramadol as the general analgesic and if methocarbamol for muscle spasm pain every 8 hrs could help Augie with post-op pain of being unusually quiet, not moving as much, yelping, grunting when lifted.
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Post by Elisa & Augie on Aug 4, 2020 9:00:04 GMT -7
Hi, thank you to both of you for your responses. I called my regular vet today to talk to them (they saw him initially and they have been keeping tabs on him since I brought him home) and am waiting for a call back and will talk to them about the pain meds and the other meds you mention below. That said, he seems a bit more comfortable today, which is good. Less grunting and groaning when I picked him up to go out to potty (and that was before his AM pain meds), so maybe he is feeling a bit better....??
Thanks for also talking me off the ledge! I just want him to have the best recovery as possible and I worry about him. I also think what has thrown me a bit is his recovery seems (is?) slower than when I went through this with my other dog, but Augie's injury was more severe and he is a different dog, so I shouldn't be comparing. I am definitely keeping him very quiet (no running or chasing anything now - he would love to, though!) and only allowing him out of his crate to potty (which is when I do some of his PT). I have to keep reminding myself that this isn't a sprint, it is a marathon....
He has his post op visit with the neuro on the 25th, so I am hoping he is doing well and can move on to some additional PT / exercises (e.g. water therapy - he can't go in the water for another week because of his sutures). I definitely want to get him moving a bit more, but am sticking with the PT and massages for now.
Thank you again for for the helpful information - I will keep you posted on his progress!
Elisa
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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 4, 2020 9:44:32 GMT -7
Look forward to hearing what your vet Rx's so that there is complete relief round the clock from pain. ANDY discomfort (pain) nearing next dose of the single pain meds, indicates the pain treatment is not yet correct (how often given, whether a combo pain med cocktail is needed)/
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Post by Elisa & Augie on Aug 18, 2020 8:33:35 GMT -7
[Second surgery Aug 13, 2020] Hi - so since I last wrote, Augie took a turn. Last Monday [8/10] he started off fine (and had been acting very comfortable for a number of days), then by mid-day I could tell he was feeling painful. I took him to the emergency vet at UC Davis [8/10] and they upped hispain meds (▲ gabapentin 3x/day vs 2). We went back Tues because after 24 hours he still wasn't feeling good so they put him on ✙ Metacam (1ml/day). Wednesday [8/12] he was definitely acting more comfortable, but still not wanting to walk. Unfortunately, when I took him out Thursday, he was very weak, so back to UC Davis we went. He ended up having another surgery [8/13] - 4 weeks to the day from his first - as he had another disc issue/herniation. An unexpected benefit was they could see how his spinal cord looked and if it was healing well (it was), but he had a very swollen nerve root. I brought him home last night and while he is very hunched (which hopefully will go 'down' some over time), he is urinating on his own and is not on any pain medication. When I picked him up, he was much happier to see me than he acted after the first surgery (he was trying to get out of the doctors arms, wagging his tail, licking -- lots of licking) and was very excited last night. He is only on Trazodone (1/2 pill - 25mg - every 8 hours) and he is quieter this AM (which is fine as rest is good right now) but he did eat his breakfast so that is a positive sign -- he doesn't eat when he doesn't feel good. [Moderator's Note. Please do not edit
11.5-12lbs
Surgery #1: 7/17
Surgery #2: 8/13
Trazodone 25mgs 3x/day]So, we are 'resetting' the recovery clock, but hopefully we have fixed all his issues and we can now work on healing. One thing I was looking into was doing laser therapy - does anyone have any experience/feedback on that (and when it may be good to start)? Elisa |
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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 18, 2020 9:40:57 GMT -7
Elisa, sorry to hear another surgery for Augie. So good to hear that he is out of pain!!!!
For how many weeks does the surgeon want for crate rest for this second surgery 4 weeks after surgery #1.
Was it the same disc or a new disc?
Laser therapy can be useful when there is an issue that could benefit such as with paralyzed legs, to kick start the nerves to self repair.
Tell us more about Augie's neuro status so we know more how to comment.
Can he walk on his own?
Is he wobbly and needs sling support at potty times?
Do his paws knuckle under, or is he slow to right his paw?
What did the surgeon direct for at home PT? For dogs who are able to walk, often the PT is the walk to and from the potty place.
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Post by Elisa & Augie on Aug 19, 2020 8:24:46 GMT -7
Hi Paula, I know. Poor little guy, but I think that was why he may have not been totally comfortable leading up to the second surgery. At least he seems more comfortable now.
The neurosurgeon said strict crate rest until recheck (which I scheduled for 9/21 - 5 weeks post op.) Based on his recheck, he can start introducing more activity, more PT, etc.
I think this was actually in the same place, but different disc (and different side - his first surgery was to the left; this was to the right). His initial surgery was a hemilaminectomy T13-L1, L1-L2; this was a right side pediculectomy T12-L2.
I do plan to start him on laser therapy tomorrow - my regular vet is about a mile away and so I can easily get him over there 1-2x/week. I have heard great things about laser therapy so I am hoping it will help him - I do not think it can hurt him, so I am willing to get it a shot!
As for Augie's neuro status:
- He can walk on his own. He isn't walking much, but I am surprised at how much strength he seems to have. He is wobbly, but can support his own weight to potty. He back is quite hunched/arched, so the biggest issue right now is when I take him out he basically urinates on his front paw (and a bit on his belly). Hopefully that will relax a bit in the coming week or two.
- He is definitely knuckling. He had DPS in both feet before both surgeries, but I noticed his superficial feeling has regressed a bit (again.) Prior to this surgery, he was getting more superficial feeling in his paws (i was tickling, pinching, his feet and toes to see what I got a response), so I think we just took a few steps back again.
- The neuro said strict crate rest and to carry him to/from potty. I am doing leg massages and some bending and stretching of toes, knees, hips. I am trying to keep him standing for a while (1 min - or more, if I can - right now) every time I take him outside.
Right now, he is sleeping a lot (which I assume is a combination of the sedative and the fact that he probably didn't sleep much at the hospital - he is a nervous little guy), but I think I may cut him back to 2x/day on the Trazodone and see how he does. I don't want him to get too excited/active so I just need to monitor that.
Elisa
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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 19, 2020 9:12:38 GMT -7
Elisa, what a relief to be out of pain and he definitely has DPS with being able to walk even if wobbly! "The ability to perceive superficial pain is typically lost at the same time that voluntary motor control is lost." Since Augie has motor control even if wobbly, he then by definition must have superficial pain. Augie's body will self heal the nerve damage that is causing the knuckling. Maybe the Laser will kickstart the healing to happen faster. Augie has pretty mild neuro damage so with time he'll very likely be able to self repair even with the nerve department to be one of the slowest parts of the body to self-heal. The laser can also help kickstart the healing of the cut surgical sites. Just pad out his travel crate so his body is stabilized. Use rolled up blanket or towels snug around him so he won't shift as you brake or corner.  Let us know how the vet visit goes. |
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Post by Elisa & Augie on Oct 9, 2020 15:13:26 GMT -7
It has been a while since I posted an update on Augie. We are now 8 weeks post op #2 (12 weeks post op #1) and he is doing well. **  He has been getting laser therapy 2x/week but the vet thinks we can stop that now. He has also been getting acupuncture 1x/week or about 5 weeks now and he started hydro therapy a little over a week ago (he has had 3 sessions and will have at least 7 more and then we will reassess). We have also been doing some PT for about 5 weeks - it started with basics (sit to stand, balance, massage) and now we are doing more strength and coordination (hills, turning, etc.)
The good news is he is mobile and when he 'trots', you cannot tell he has any neuro deficits -- unless of course he looses his balance (e.g. steps on something uneven) in which case you can see it is a bit harder for him to right himself. He does have quite a swagger to his walk and you can see that his legs do look a bit weak, but he is walking without any assistance and his toe drags seem to be less (you can still hear it, but it is every few steps vs every step). He is still knucking a bit, but he is responding MUCH faster (almost immediately now). I am hoping with more time his nerves will continue to heal (and he will continue to get stronger). He was basically in a crate for over 10 weeks straight between his surgeries so I do think it will take him longer to build back those muscles. I want him better NOW, but I have to remind myself this is a marathon, not a sprint.
He has been off ALL pain meds since I brought him home from the hospital the second time - he was on pain meds for almost the entire 4 weeks after his first surgery, so clearly whatever was still going on was fixed in the second surgery.
I am giving him some supplements per the rehab vet at UC Davis: - Davinci Labs Perna Plus (1/4-1/2 pill per day) - Kan Essentials Supple Spine (1/2 pill 2x/day) - Dr Mercola Complete Probiotic (1 scoop per day)
I am also giving him (which the vet is aware of):
- VetriScience Vetri Disc (1 capsule per day sprinkled over food) - Salmon Oil
We are also working on his new normal - e.g. not running around like a lunatic and trying to jump. He is a good boy in that when I tell him "no" or "nope" he knows what that means and stops. He also (usually) listens when I tell him to stay. He did try and jump up on a chair in my living room (before I could tell him NO) and all he could do was a tiny bunny hop, so I don't have to worry about him getting up on anything anytime soon! I will need to keep an eye on him as he gets stronger, though. We have a long way to go, but even if he is never 'normal' at least he will be able to get himself around which, as far as I am concerned, is a big win after all he has been through.
Elisa
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Oct 9, 2020 18:40:24 GMT -7
Elisa, congratuations on Augie's graduation! It is still early in the nerve healing department, could well be more improved nerve function to come. Is the water therapy, underwater treadmill? That is supposed to be the best in helping with the art of walking, learning to coordinate muscle with nerve messages. Sounds as though now is the time to train Augie to use a ramp. That way when he has ability, he'll be trained to always take the ramp. Please celebrate Augie's graduation! Add a graduation photo to our Gallery to give other members inspiration about your IVDD Survivor! dodgerslist.boards.net/thread/2262/add-dog-dodgerslist-photo-galleryDetermine how you are going to ease back into more normal activity at graduation. The idea is to gradually give more freedom under controlled conditions. Not free riegn of the house and yard immediately! LOL Take a look at our information and then come up with a plan to gradually increase activity over about a month's time following the end of crate rest. Lots of good tips and ideas for back friendly activities for Augie including how to use a ramp by a professional trainer: dodgerslist.com/2020/06/15/back-friendly/ and dodgerslist.com/living-with-ivdd-tips/ Do stop in when you are able, we would LOVE to hear how things are doing with Augie's training and nerve improvement. |
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