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Post by Dr. Ida & Jaime on Jun 3, 2021 8:10:32 GMT -7
[Original subject line: Happened in 2.2 Seconds] Fentanyl Patch 25 MCG-Comes off today. Tramadol 50 MG Tablets-1/2 Tab every 12 hrs. Methocarbamol Tablets 500 mg-muscle relaxer-1/2 Tab every 8 hours Enrofloxacin FlavorTabs 68 mg-Antibiotic-1 1/2 1X a day. Prednisolone Tablets 5mg-Steroid-1 a day for 4 days. Then 1 every 48 hrs.Start Date was date of surgery 6/1/21. Famotidine Tablets 10 mg-Antacid-1/4 every 12 hrs. L- Carnitine Powder-Muscle supplement-1/4 tsp in food twice a day. Prazosin Tablets .5mg.-1 tab every 8 hrs Pregabalin 50 mg Capsules-Nerve Pain-1 capsule every 12 hrs. [Moderator's Note. Please do not edit 24lbs Prednisolone as of 6/1: 5mgs 1x/day for 4 days, then 6/5 taper methocarbamol 250mbs 3x/day traMADol 25mgs 2x/day pregabalin 50mgs 2x/day Enrofloxacin 68mg tab: 102mgs 1x/day Prazosin 0.5mgs 3x/day famotidine 2.5mgs 3x/day]
My Jaime weighs 24 lbs and he is a beautiful Beagle. My name is Ida Miller or Dr. Ida Miller. Jaime had surgery on the 1st of July for a herniated Disc. He is at home now but still cannot walk with his hind legs or urinate on his own. A Neurologist performed the emergency surgery to try to help Jaime. Dr. Pierre Bichsel DVM, MS at the Animal Specialty and Emergency Hospital was called in on Saturday June 1 when Jaime jumped off the bed that morning and did not Yelp or make a sound but did not use his back legs after that moment. Jaime's world changed from that jump! Jaime currently is carried outside by me to poop and I help him urinate every hour. I help him stand to try to help him start to get some of his mobility back. He was given a 95% chance of walking after surgery. Jaime does not have bladder control. I am hoping that this will come back as we start to get off of all of these meds.
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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 Jun 3, 2021 10:03:01 GMT -7
Dr. Ida, welcome to the Forum, we are glad you are here. Your quick action to get vet help, was an excellent effort in preserving enough nerve function to allow regeneration of nerves. The body can self repair nerves. How long that would take is dependent on how much and how severe the damage was. Often we need to think more in terms of months rather than days/weeks for this slowest part of the body to heal. Also there can be a temporary setback due to the surgery cause swelling. That swelling often subsides in about 14 days where you get a better idea of the path of healing. EXPRESSING the BLADDER Expressing the bladder is a new skill to be learned. The goal is for Jaime to stay dry between expressing sessions. While on prednisone you would need express every 2-3 hours as you are perfecting this new skill so there is no leaking in his bedding. Eventually you will move up to every 3-4 hrs and then every 6-8 hrs. -- Can you feel the bladder? When very full, it fills the the tummy area and takes little pressure to express. When it begins to empty, it may feel like a plum. It may escape your hands and move back into the pelvic area. -- The goal you'll be reaching by the end of a week's worth of expressing is to be able to feel the bladder at the last stage. It will be quite empty allowing one hand to almost feel the fingers of the other hand it is so flat. -- Let us know what you feel. Don't hesitate to return to the surgery hospital or your own vet for a refresher. There YOU will express and the vet or vet tech will check your work, give you extra pointers. Also a good video with lots of tips on expressing here: dodgerslist.com/2020/05/05/bladder-bowel-care/ Note that you can also express for poop. Poop is not the health issue urine is. It is to avoid Jaime having anxiety in finding poop where he sleeps. PAIN surfacing? Let us know the current pain meds (methocarbamol, traMADol and pregabalin) are fully controlling pain round the clock and dose to dose. If not advise the surgeon so the meds can be tweaked for necessary full pain control. MONITORING NEURO FUNCTION Upon discharge to home, did the neurosurgeon say if Jaime had regained deep pain sensation (DPS)?
FAMOTIDINE (Pepcid AC®) Could you confirm the dose given. One fourth of a 10mg famotidine tablet is quite small @ 2.5mgs twice a day for a 24 lbs dog. Does Jaime have liver or kidney issues?POST-OP REST -- The recovery suite will be protection while the surgical sites heal. Your pictures show a rather too small an area for the suite. The suite needs to be large enough to easily turn around and fully stretch out his legs when lying down. This link will detail many good ideas, tips and types of suites. Let us know what you have decided on. dodgerslist.com/2020/05/14/strict-rest-recovery-process/
-- What did your surgeon direct for the number of weeks of post-op rest which would include his directives for physical therapy at home or a clinic? Some want 4 weeks and other cases may need more like 6 weeks.-- Which at home post-op exercises or others did your surgeon want for Jaime?
Appropriate physical therapy can help maintain the muscles with lost nerve connection. Therapy keeps muscles in optimal condition while waiting on regenerating axon terminals.
Post-op PT for the paralyzed IVDD dog:
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Post by Dr. Ida & Jaime on Jun 7, 2021 2:21:39 GMT -7
My biggest concern right now is that every hour I take Jaime out to the grass to express his bladder and I have him try to stand at that time but he smells like urine and his pelvic area is very red. This worries me because his urine still smells strong even after he drinks every time we come in from his 5 minutes outside. He is constantly licking himself while he is sitting down. This is keeping his pelvic area wet when I would love it to dry out. constant craziness. Jaime is so good natured and loving, I only want him to feel better.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Jun 7, 2021 7:16:41 GMT -7
Dr. Ida, here are some things to consider: -- Is Jamie still taking antibiotic Enrofloxacin? If it has been stopped, then has a urinalysis been taken to prove Entrofloxacin killed the bacteria. Often when a dog licks genitals is because they can smell the bacteria. Maybe Entrofloxacin was not a match for the specific bacteria in the bladder? -- Learning to express is a new skill. Now that Pred is in the taper Jaime should be drinking less water. Your proficiency level in feeling the shape of the bladder with your hands should be allowing you to feel when it is so flat that one hand can almost feel the other hand. That stage would mean the bladder is pretty empty. What do you feel?
Have you taken Jaime back to your vet or the the surgeon's hospital where you express there and then the vet tech checks your work, give you extra tips. -- With prednisone in the taper, expressing should be able to go to every 2-3 hours. -- Discuss with the vet if Prazosin should be adjusted if it could be causing too much relaxation. This drug relaxes the neck of the bladder to make it easier for urine to escape the bladder when expressing. -- After expressing, be sure to wipe all urine off of skin and fur. A very real concern is this redness could move to broken skin and a difficult staph infection that would need an antibiotic cream from your vet. --- Is his bedding staying dry? Do you have his mattress set up properly to avoid Jaime laying in dampness? This tip and many other good ones comes including how to set up the mattress system from our supply list at the Main Dodgerslist web site. dodgerslist.com/2020/05/14/strict-rest-recovery-process/Use unscented baby wipes for quick clean up on your dog. Marjorie's tip: Brew up a pot of decafinated green tea. Let it cool, dampen a sponge or cloth with the tea and then gently wipe belly and legs. Tea is mild with acidifying, antibacterial properties to neutralize urine on skin and fur to avoid rashes from urine scald. The tea leaves a clean earthy fragrance. The remaining tea can then be stored in the refrigerator and warmed before use. 2 NO-ZINC Urine Barrier creams Aquaphor Baby or Aquaphor regular Healing Ointment contain same ingredients: Petrolatum (41%) Inactive Ingredients: Mineral Oil, Ceresin, Lanolin Alcohol, Panthenol, Glycerin, Bisabolol Bayer's A+D® Original Ointment Active ingredients: Lanolin 15.5%, Petrolatum 53.4%QUESTIONSUpon discharge to home, did the neurosurgeon say if Jaime had regained deep pain sensation (DPS)? What did your surgeon direct for the number of weeks of post-op rest which includes any directed PT? Which at home post-op exercises are you doing at home? Please keep us updated on what the vet said and if you took Jaime in for another expressing lesson.
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Post by Dr. Ida & Jaime on Sept 6, 2021 3:38:01 GMT -7
My Fighter Jaime Well Jaime is completely finished with Rehab. He is walking much better, in fact, he is trying to jump on the furniture which we have to completely block off from him while we are at work. The Animal Specialty & Emergency Center at 2281 Eau Gallie Blvd, [Melbourne, FL] 321-725-5365 did an amazing job helping Jaime recover from this unfortunate, but crazy accident. Kudos to the staff that worked tirelessly one-on-one with Jaime throughout his rehab. They fell in love with him and treated him like their own. It was expensive, but thank GOD, we were able to pay it and get him to the point that he is back to his rambunctious loving self! Jaime is worth every cent! I included this right after surgery trying to walk with this post. I knew that Jaime would get better, because he is my little fighter and my entire summer was dedicated to helping Jaime walk again-no matter what. Like I wrote in the beginning, it was all for my LOVE-Jaime!
Thank you to Dodgerslist.com for the help that you gave me through this trying period!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,493
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Post by PaulaM on Sept 6, 2021 9:14:12 GMT -7
Dr. Ida, so very happy to hear Jaime is now able to walk!!! Your dedication to care, Neuro Bichsel's decompression of the cord, good support of the PT team and Jaime's determination to relearn the art of walking contributed to this very happy outcome! You'll find good pointers and things to consider in living many happy years ahead with your IVDD Jaime. Fun activities, how to handle dentals, nail trims, car travel and more: dodgerslist.com/living-with-ivdd-tips Would you consider helping another trying to make decisions… We have a directory where you can share surgical info. Here is where you can share your dog's info: dodgerslist.boards.net/board/13/member-reported-surgery-costs-recommendationsState: Hospital: Address: Cost: Date of surgery: What was included in cost (MRI?, days stay, ER? PT? meds for home, sling, etc.) Comments: Dr. Ida, we appreciate your update to know how Jaime progressed after his surgery. Thank you for the sweet mention the Forum was helpful to you!
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