Bearly slept fine through the night 10/01/2020. He
peed on his own around 5 pm when we stopped on the trip home. I set him in the grass and held up his back end. I had planned to express him since he had is Diazepam at 4:40 PM but when I put him down he peed on his own. I did try and express as well but no additional urine came out.
I tried to express when we got home 10/01/2020 before bedtime, but nothing and again this morning 10/02/2020 when we first got up at 6 am. Still nothing, however
his bedding was wet.
He will have his meds at 8:00 am and I will try again to express about 20 minutes later. He has had 2 bowel movements since coming home.
I have watched the express videos over and over hoping that this morning we have better success.
Here are the details from the hospital
Name: Bearly
Age
2 years 8 monthsWeight
13.78 lbsBreed - Pekingese Pomeranian Mix
Veterinarian: Dr. Christian Folk (Surgery) Dr. Rebecca Sandler (discharge),
Cornell University Hospital for AnimalsCASE SUMMARY:
Bearly, a 2-year-old, male neutered Pekingese was transferred to the CUHA neurology service on 09/26/2020 for paraplegia (hindlimb paralysis) that occurred the evening of 09/25/2020. Neurologic examination revealed
paraplegia in the hind with absent pain sensation bilaterally. Point of care blood work revealed values within normal limits. Bearly was placed under general anesthesia and a thoracolumbar MRI was performed which revealed herniated intervertebral disc material at the L2-L3 disc space. Following the MRI, a left hemilaminectomy at the
L2-L3 disc space was performed on the afternoon of 09/26/2020. The procedure was routine and Bearly did well under general anesthesia. He was recovered overnight in the ICU and the following morning his neurologic status was unchanged compared to prior to surgery.
Bearly was hospitalized in the ICU following surgery for intravenous analgesics and bladder expression. He was gradually transitioned to oral pain medications and was comfortable on these medications. Bladder medications were adjusted to help aid in bladder expression in the hospital. He was discharged 10/1/20 for care at home. At the time of discharge, Bearly was still paraplegic with
no deep pain sensation [10/1/20].
Because Bearly had a lack of deep pain sensation on presentation, the prognosis for return of function (walking) is approximately 50/50, although some neurologic deficits may still be observed long-term. The recovery time is several weeks to months and improvement takes time, if it occurs. He must be
strictly crate rested in order to prevent worsening of his condition or any setbacks in his recovery. As we discussed, intervertebral disc injuries typically result in both compression of the spinal cord as well as bruising of the spinal cord from the impact of the disc rupture. While we were able to remove the compressive disc material, the bruising takes time to improve, which leads to a significant variability in recovery times between dogs.
MEDICATIONS:
1.
PREGABALIN 25 mg capsules: Give 1 capsule (25 mg) by mouth twice daily (every 12 hours). This neuropathic pain control medication is very safe for long-term use. The primary side effect is sedation.
DOSE DUE: 8:00 AM and 8:00PM
2.
TRAZODONE 50 mg tablets: Give 1/2 tablet (25mg) by mouth 2 to 3 times daily (every 8 to 12 hours) as needed for anxiety. This anti-anxiety medication will help keep Bearly calm during crate rest. The primary side effect is sedation. NEXT DOSE DUE: As needed
3.
METHOCARBAMOL 500 mg tablets: Give 1/2 tablet (250mg) by mouth
every 8 hours for muscle relaxation. This medication can be used long term if needed to aid in bladder expression. This is a muscle relaxant and the most common side effect is sedation. DOSE DUE: 8:00 AM and 8:00 PM
[an every 12 hours schedule!?]4.
PRAZOSIN 0.5 mg capsules: Give 1 capsule (0.5mg) by mouth
every 8 hours to help with urination. This is a muscle relaxant for the bladder sphincter to make it easier for Bearly to urinate on his own. It is typically well tolerated in dogs but can cause gastrointestinal upset and low blood pressure. DOSE DUE: 8:00 AM and 8:00 PM
[an every 12 hours schedule!?]5.
DIAZEPAM 5mg tablets: Give 1 tablet (5mg) by mouth 20 minutes prior to bladder expression 2-3 times per day
. Max daily dose of 3 tablets. This is a muscle relaxant and the most common side effect is sedation. DOSE DUE: 8:00 AM and 4:00 PM
[Moderator's note: please do not edit
13.78 lbs 2.8y.o
Pregabalin 25 mg 2x/day
Methocarbamol 250 mg 3x/day
Prazosin 0.5 mg 3x/day
Diazepam 5mg 20 minutes prior to bladder expression 2-3x/dayTrazodone 25 mg 2-3x/day as needed for anxiety]
2. STRICT ACTIVITY RESTRICTION: Keep Bearly on strict crate rest for a minimum of
4-6 weeks to encourage his back to heal and prevent exacerbation of his injury. It is critically important you follow these guidelines for confinement and controlled exercise. We understand it is difficult, but it is imperative for the healing process.
Post-operative healing of the surgical site takes at least 6 weeks, so it is imperative that Bearly be well-rested during this time so that he does not cause additional injury to his spinal cord. Strict rest means no jumping, running, using stairs, playing rough with other dogs, or any off-leash activities.
All high-impact activities should be avoided. At all times, restrict Bearly to a crate or small gated area (smaller than a small bathroom) with no high surfaces to jump off. The crate should be large enough to have bedding, food, and a water bowl. The only time Bearly should be allowed out of the crate is for
3-5 minute "potty break" walks. Bearly should always be on a harness and leash when outside to go to the bathroom, and as soon as he has gone to the bathroom, he should be carried back inside. If needed, use the provided sling to support Bearly when walking.
3. NURSING CARE: Bearly's crate should have plenty of soft bedding. You should flip his hips a few times throughout the day to prevent pressure sores (bed sores). If you do notice any sores developing, let us know immediately. Because Bearly will still drag his paws for a period of time, you can purchase booties or small socks to put on his feet when walking outside to prevent damage to the skin on the tops of the paws.
4. INCISION: Monitor the incision site for redness, swelling, or any discharge. If you are concerned, contact the Neurology Service or your primary care veterinarian. Do not apply anything to the area and allow it to heal on its own. Do not bathe Bearly until instructed to do so after his recheck. Spot cleaning with baby wipes or waterless/foaming shampoo is OK.
5. URINATION: When dogs lose motor function to their hind limbs, they typically lose the ability to voluntarily urinate. If Bearly starts to regain motor function in his hind limbs, he may be able to void urine on his own. Until then, palpate Bearly's bladder 2 to 3 times per day and, if large, express onto a pee pad, towel, or grass as demonstrated. We have added medications to Bearly's regimen to make his bladder expression easier.
The website www.dodgerslist.com has information and videos on bladder expression that you may find useful. If you notice dark or foul-smelling urine, have Bearly checked for a urinary tract infection with a urinalysis and urine culture. If Bearly has not urinated in more than 18 hours and you are unable to express him, have him evaluated by a veterinarian immediately. The inability to urinate is a medical emergency and can lead to urinary bladder rupture.
6. RECHECK: We would also like to reassess Bearly's neurologic status again in 4-6 weeks. At this appointment, we will discuss activity restriction and any medication alterations. Call sooner if you have any concerns.
7. PHYSICAL REHABILITATION: Two to three times per day, perform the following exercises on Bearly's legs.
- Massage the entire limb: Gently massage the limbs for 2-3 minutes to stimulate blood flow to the musculature and to relax the muscles.
- Passive range of motion: Bearly may lie on his side while performing these exercises. Beginning at the toes, flex and extend the digits for a total of 10-15 repetitions. Move up to the ankle and flex and extend the joint for a total of 10-15 repetitions.
Repeat at the level of the knee as well as the level of the shoulders. This exercise helps increase joint mobility and relaxes the tendons and ligaments that may be rigid.
- Weight bearing exercises: Perform standing exercises to increase strength and balance. Begin this exercise by placing Bearly in a normal standing position with all paw pads on the ground. Let Bearly bear his weight until the legs collapse. At that point begin the exercise again. This exercise should be done for approximately 5 minutes 2 to 4 times per day.
- Weight shifting exercises: After Bearly can stand on his own for approximately five minutes, you can begin this exercise to challenge balance. Place Bearly in a standing position. Begin to gently sway him from left to right and forwards and backwards. You should not rock him so far that the front legs have to move to help balance. As Bearly regains more balance, you will provide less and less support. Weight shifting will help strengthen Bearly's spinal muscles and improve proprioception. Have Bearly stand on a non-slip surface to perform these exercises.
