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Post by Stacy & Charlie on Sept 15, 2021 4:58:27 GMT -7
[Original subject line: Charlie is Home…]
Hi, I feel so desperate…charlie (bichon/poodle) came home [9/14] from ER surgery for ivdd yesterday at 5pm. Since being home, he has peed himself 2x, we have expressed his bladder 2x, and he just pooped on me as I was holding him (first poo since entering the ER last Saturday).
He did drink and eat his new soft food, going to transition him back to dry food slowly, so I guess that is good. He took his prednisone, trazodone, and gabapentin with peanut butter….He yelps when we express him and takes a few times and is so scary to me. He is still paralyzed in his back legs. I know we have not been home 24 hrs but feels so hopeless. I keep trying to clean up his pee stained fur bc afraid of infection as well. I just want my pup back….how do I know if he is doing better? Any tips would make me grateful. Thank you.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Sept 15, 2021 9:10:57 GMT -7
Welcome Stacy! First days home can be overwhelming with many new things to learn and get a routine established. For sure there is good hope that it IS in the cards for Charlie to get back to a happy pain free life. Do know that the surgery itself can cause some temporary neuro set back. It may take about 14 days before all that painful swelling is gone and you and your surgeon can best see the path of healing.
It will help us work together with you and avoid offering ideas that could cause harm or lead the discussion in the wrong direction delaying help for your dog — please share a bit more detail with us: EXPRESSING Yelping is not normal when expressing. Call the surgical clinic and tell them. It may be the pain meds are not yet right or maybe as most of us we needed another hands-on-top-of-your-hands type of expressing lesson. If closer, your local vet or vet tech can help with expressing. Get more out of another lesson by first reading and viewing the video for both bladder expressing and poop expressing: dodgerslist.com/2020/05/05/bladder-bowel-care/ Setting up the recovery suite can make life easier for maintenance, etc. Good reading right now — super tried and true tips for setting up the recovery suite, the mattress and using green tea to clean up urine in fur and more! dodgerslist.com/2020/05/14/strict-rest-recovery-process/ ☆ 1 Is there still currently pain from the post-op swelling? ☐ reluctant to move much in crate such as shift positions or slow, ginger movements ☐ shivering, trembling ☐yelping when picked up or moved ☐ tight tense tummy ☐can’t find a comfortable position, restless Full pain relief is expected in 1 hour and stays that way dose to dose. If not in control your vet/surgeon needs to know asap to adjust meds ☆ 2 What is your dog's weight? How old is Charlie? A.. List the exact names of all meds currently given, doses in mg’s and times per day given. Prednisone ?mg ?x/day for how many days, then a reduction.
gabapentin ?mg ?x/day
traZODone ?mg ?x/day
C.. PEPCID AC: Ask if Charlie has any health issues that would prevent use of Pepcid AC (famotidine)? If you get a "no health" issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine). WHY PEPCID AC is important while taking Prednisone: dodgerslist.com/2020/05/06/stomach-protection/(NOTE: Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. www.1800petmeds.com/Famotidine-prod11171.html ) ☆ 3 -- Eating and drinking OK? No nausea/not eating, no vomit? -- Poops OK - normal firmness & color. No loose stool or diarhea? -- no dark black or bright red blood indicating bleeding ulcers? What is the name of the new soft food? Best to not transition foods when still taking prednisone. What is the reason you are wanting to transition now to dry kibble?☆ 5 -- Is the surgeon a general DVM or a specialist surgeon: ACVIM neurology or ACVS ortho? Did the surgeon say if Charlie had the neuro function deep pain sensation (DPS) ability prior to the surgery? After the surgery did the surgeon say he has (DPS)? ☆ 6 SURGERY date? SURGICAL dogs will follow surgeon's directives for rest & PT during post-op rest as the offending disc material was removed. -- How many weeks did your surgeon direct for post-op rest? -- What did your surgeon direct for clinic or at home PT? In the next several days take the time to educate yourself. Knowledge is the key to soothing your mind and looking out for your Charlie. 1) Emergency FAQ will fill you in on the big picture. It helps to plant a seed in your mind: dodgerslist.com/2020/02/24/emergency-faq/2) Be in the know how each phase of healing works. "Improvement" is too vague a term. Have meaningful conversation about the specific expectations of healing for your dog with your vet: dodgerslist.com/in-the-right-place3) Nursing Care Tips— No need to reinvent the wheel with at-home nursing care during a disc episode: dodgerslist.com/2021/01/19/nursing-care-at-home-tips/ Look forward to learning more about Charlie and where we might best help you. |
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Post by Stacy & Charlie on Sept 16, 2021 8:11:20 GMT -7
Hi,
Charlie had surgery on Sunday, Sept 11th. He had left sided L2-L3 intervertebral disc herniation causing marked spinal cord compression. A left sided L2-L3 hemilaminectomy was performed.
He has deep sensation in his right hind limb and superficial pain in his left hind limb. We have him on strict crate rest.
His medications are 5mg of prednisone with 3/4 tablet for 7 days, 1/2 tablet for 5 days, and 1/4 tablet for 5 days. In addition he is on 50 mg Trazadone at 1/4 tablet every 8-12 hours and Gabapentin 50 mg given 1 tablet every 8-12 hours.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
weight 3 y.o.
prednisone 5mgs tablet?: ?mg ?x/day for 7 days
trazodone
gabapentin 50mgs which? every 8 or 12 hrs ]
He is drinking but not much, eating his soft food 2x a day. He does leak in his pee pads. Expressing has been a challenge. He does yelp and nip although we have been successful 35% of the time.
I did take him to our home vet [9/16] at 7:30 this morning and she expressed him fully and he also yelped at her. She said she is not concerned about a UTI as his urine looked and smelled normal. She said he yelps bc he senses our nervousness and his back hurts/sore bc of the surgery and we are pushing in his bladder which causes pressure.
We also finally bathed his under torso and hind legs that have been wrenched in urine no matter how many times I have wiped him down. We also got him to defecate for the second day with the i e cube method and it seems he tried to get in position with our assistance. Charlie also did a mini shake off last evening. Is that a good sign? What are your thoughts on the bladder expression? He honestly will yelp as my hands approach his back end to attempt the expression but have not even touched him. I just want my pup back….only 3 yrs old. I am correct that i can not do any physical therapy until my 2 week check other than my own leg movements etc? Thank you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Sept 16, 2021 11:42:11 GMT -7
Stacy, call the neuro and report very possible actual pain. There is also anticipation of pain of yelping before you even touch. To make sure there is actually NO pain of discomfort, advocate for a stronger pain med approach. Tell the neuro your problem with expressing. Which are you actually giving gabapentin? Every 8 or every 2 hours. You ShOULD be giving promptly every 8. Let us know what you were giving and what the neuro Rx's today to adjust for full comfort. Verify with your neuro if any of these post-op physical exercises in video below can be done for Charlie's back legs. IF not advised to start today, then when is it ok to start? Always ask, ask lots of questions. What PT at home are you doing that was directed by the surgeon? Appropriate physical therapy can help maintain the muscles with lost nerve connection. Therapy keeps muscles in optimal condition while in wait to receive regenerating axon terminals. Post-op PT for the paralyzed IVDD dog: QUESTIONS What is the name of the new soft food?
How many weeks did your surgeon direct for post-op rest?
Are you using green tea to clean fur and skin of urine?
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 doxie. 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.
White vinegar in a spray bottle to disinfect and remove the urine ammonia smell from floors, etc. Best is to have two spray bottles, one filled with plain white vinegar the other filled with peroxide. A spritz of each on urine and poop disinfects and completely removes the odor... good on linens, floors and other hard surface. Pre test peroxide for color fastness on important fabrics. At Costco you can purchase 2 qts hydrogen peroxide for about $3.00
As last resort til you can get pain in control in order to express AND that you have reached expressing proficiency that he stays dry session to session (about every 2-3 hrs, then working up to every 3-4 hrs, and so forth. Goal is you can express every 4-5 hours.
Try using baby diapers or maybe human diapers to catch urine and wick from skin. Sorry not knowing Charlie's size/weight am just able to offer suggestions.
To prevent urine scald:
Aquaphor Baby or Aquaphor regular Healing Ointment contain same ingredients: Petrolatum (41%)
Inactive Ingredients: Mineral Oil, Ceresin, Lanolin Alcohol, Panthenol, Glycerin, Bisabolol
aquaphorus.com/categories/
OR
Bayer's A+D® Original Ointment
Active ingredients: Lanolin 15.5%, Petrolatum 53.4%
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Post by Stacy & Charlie on Sept 18, 2021 9:13:12 GMT -7
We have been able to get expressing going and he loves his stroller walks/eating, etc.
Questions
1. We are doing the home therapy exercises but when do you know it is a lost cause? I know that sounds so soon to ask only 6 days post surgery but I am trying to understand the situation and how it is impacting an extremely busy family with 3 kids and 2 working FT parents.
2. What are good signs of progression?
3. Is there a specific rehab therapy that is better than another? Since we gave already spent around $11k, just trying to gage.
4. I “see” my furry baby still in his face most of the time and am doing literally everything possible such as daily leg/under belly baths to remove urine stain etc, changing pee pad 4-5x daily, walks in doggy stroller, feeding, meds, contact with surgeon, followup scheduled, looking into rehab once I get green light etc. I just can’t see us living with a dog like this in 4-5 months…not fair to anyone…
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Sept 18, 2021 10:11:04 GMT -7
Stacy, still some questions (I don't think you saw asked) so we have a complete picture of Charlie before giving comments. QUESTIONS
🍫What is the name of the new soft food he is currently eating?
🍫How many weeks did your surgeon direct for post-op rest?
🍫How much does Charlie weigh?
🍫Are you using green tea to clean fur and skin of urine? tip is in an above post.🍫Which are you actually giving gabapentin 50mgs for post-op pain? Every 8 or every 2 hours?🍫What PT are you doing at home and how many times a day?🍫What did the neuro say when discussing yelps during expressing. Were pain meds adjusted? The nerve healing department is the slowest part of the body to heal. Often we ought to think more in terms of months rather than days/weeks. No one will be able to give you a date for nerve healing. All that is known is the predictable typical order in which nerve function comes back.
1. Deep Pain Sensation (DPS): the first neuro function to return. DPS is the critical indicator for nerves to be able to self heal after surgery or with conservative treatment. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about this very tricky to correctly idenfiy neuro function.
2. Tail wagging with joy at seeing you or getting a treat or meal is something anybody can correctly identify!
3. Bladder and bowel control verified with the "sniff and pee" test.
4. Some leg Movement (excluding at potty times), and then
ability to move up into a standing position, and then
wobbly walking.
5. Being able to walk with more steadiness and
properly place the paw.
6. Ability to walk unassisted and perhaps even run.
LEARN MORE: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/
The number of weeks your surgeon wants for post-op rest to allow the surgical sites to heal, is a more intense time as you are acting as a nurse, and giving care. If time is tight walks in a stroller are not critical. Try to do some at home PT to keep the joints flexing and muscle circulation up 3x/day. If not possible then 2x a day. What age are your children? If old enough and dependable they may be able once shown how to flex joints and massage legs do some of that. UNDERWATER TREADMILL If dollars permit AND there is a clinic in your area that does underwater treadmill, it can expedite learning to walk again. With a dog who has deep pain sensation (DPS) ability and can do a happy tail wag, it may be close then in time to check into this physical therapy. The movement of the hip joints and muscles and the changes in pressure on the paws from the underwater treadmill triggers spinal cord communication with the brain. Water bouyancy makes it easier than leg movements against gravity. There is not only the potential to regrow damaged neuronal pathyways but also for neuron to muscle re-education to learn the art of walking again. Living with an IVDD dog is a new routine that naturally becomes the new normal. Before routines are established, like now, it can seem chaotic and overwhelming as each thing is something you need to think about. Routines are sorta like a reflex, you just do them without much thought or making preparation for them.
Look forward to learning more about Charlie with information to to the🍫 QUESTIONS at beginning of post. |
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Post by Stacy & Charlie on Sept 18, 2021 12:48:26 GMT -7
We have been able to get expressing going and he loves his stroller walks/eating, etc.
Questions
1. We are doing the home therapy exercises but when do you know it is a lost cause? I know that sounds so soon to ask only 6 days post surgery but I am trying to understand the situation and how it is impacting an extremely busy family with 3 kids and 2 working FT parents.
2. What are good signs of progression?
3. Is there a specific rehab therapy that is better than another? Since we gave already spent around $11k, just trying to gage.
4. I “see” my furry baby still in his face most of the time and am doing literally everything possible such as daily leg/under belly baths to remove urine stain etc, changing pee pad 4-5x daily, walks in doggy stroller, feeding, meds, contact with surgeon, followup scheduled, looking into rehab once I get green light etc. I just can’t see us living with a dog like this in 4-5 months…not fair to anyone…
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Post by Romy & Frankie on Sept 18, 2021 14:13:24 GMT -7
Good job getting the expressing going. Learning to express is difficult and takes a lot of practice. You will know you have gotten it right when you get a steady stream and Charlie stays dry between expressing session. Taking care of Charlie should become much easier once you are comfortable with expressing.
You see your fur baby in his face because he is your fur baby. That has not changed. The post-op period is difficult, exhausting and can feel very frustrating. There is so much to do and learn. It will get easier. Now that you have started to get the expressing going, you will not have to change pee pads 4-5 times a day. Expressing was the most frustrating thing for me after my dog's surgery. I sometimes felt I would never learn. Finally, I began to get the hang of it, and it became much easier to care for him.
There is no way to tell how quickly Charlie will make progress. That varies from dog to dog. After my dog's surgery, at the 4 weeks check-up, he was as paralyzed as when he went into the surgery. At least he was no longer in pain. The PT that helped him the most was walking on an underwater treadmill. It seemed to help him relearn how to walk. I don't think he would have recovered nearly as quickly without it. This type of therapy can usually begin after the stitches/staples are out. You can ask your surgeon about this. Even with this therapy, it took months for him to progress. The first sign of recovery I saw was his tail, which had been completely limp, started to wag when I spoke to him. This is often, but certainly not always, the first sign visible to us pet parents. Eventually, he did regain his ability to walk and bowel and bladder control.
The immediate post-op period is very difficult, and I still remember it. I was in tears sometimes and so tired of cleaning up. I understand your frustration and what I can say is it will get better. I have been down the road you are currently on, and I can assure you of this. |
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Post by Stacy & Charlie on Sept 20, 2021 9:00:17 GMT -7
Thank you for the response. Although we can express he still leaks and has a poo accident once in a while….I got an appt tomorrow at 9am [9/21] at a great vet/rehab facility that is going to check his incision etc ( will have been 10 days post surgery) as well as perhaps start acupuncture/laser or some other form of rehab to help with the nerves. So hoping they see something positive that I don’t…
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,541
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Post by PaulaM on Sept 20, 2021 11:34:00 GMT -7
Stacy, are you able to scroll up to Sep 18, 2021 at 11:11am Post? Would you be able to answer those question asked? It seems as there is a problem with your mobile device to view posts?HELPFUL TIP: The Forum is best viewed via the "desk top view" of a mobile phone browser app (Safari, Chrome, Foxfire). Scroll down to the bottom of the screen to click on "Desktop". i.postimg.cc/HxYJbyVY/Desktop-mode600.jpg **For every tablet, phone or laptop, the most effective way to give a reply: -- scroll down to the "Quick reply" typing area. -- Avoid using the "Reply" or the "Quote" link buttons. Quick reply allows you to scroll up and down to a previous post and then back down to the "Quick Reply" typing area to continue your own post. |
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