|
|
Post by Rob & Ralph on Sept 15, 2021 13:10:10 GMT -7
Hello all,
Ralph is a 5 year old lab/shep mutt approximately 75-80lbs. On Sunday 9/12 in the AM for potty he had very slight wobbly walking but fully functioned - we didn't know what this was and out of caution he was crated Sunday. Sunday 9/12 evening at potty time he rose to standing in crate OK, took a few odd steps out of crate, wagged his head, stumbled and fell and could not get up. His back legs were crossed and his front legs were rigid. We stood him up and he could partially use his back legs but his front legs were fully paralyzed. We took him to the local Pets ER where he was clinically diagnosed with IVDD but still had DPS. He was given predinisone, gabapetin, and methocarbomol. At the time we were not able to afford the $$$ for travel to specialist or for surgery. We took him home that night and tried to let him potty while we supported him with a harness we happen to have (full body military style harness, not a proper lifting harness). We tried several times but Ralph did not potty Sunday night.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
75-80lbs 5 y.o.
prednisone 9/12
surgery 9/15]
Monday 9/13 my wife and I both took off and we gave him water through a dropper and fed him soft food and peanutbutter for meds and soaked his dry food in chicken broth and fed by hand. We tried over half a dozen times taking him to potty, but he would not. We watched videos and tried to express but could not. Tuesday 9/14 morning my wife took him to a local Vet because we were concerned he was not going potty. At the vet's office he peed and pooped on his own. The vet confirmed the clinical diagnosis (IVDD with DPS) and suggested we get the MRI if not the surgery just to confirm the diagnosis and know what we were looking at.
Tuesday 9/14 afternoon we took him to a specialist who performed xrays and bloodwork which were both normal. He was 9/15. scheduled for an MRI today, Wednesday
The neurologist read the MRI and said Ralph has a central spinal cord impingement that is caused by either an infection and abscess (unlikely) near a vertebrae in his neck or a slipped disk. The neurologist said the central spinal impingement is what is causing the front leg paralysis but while not affecting the rear as much. She informed us the surgery for this type of central impingement requires approaching the spinal cord from the top through the muscles in his neck rather than from the bottom which is more typical. She said this surgery is more difficult, riskier, and has a lower success rate for Ralph, a rate of 80% or less.
Ralph went in to surgery this afternoon.
I am hoping to talk with people who have experience with this type of central spinal cord impingement, post op recovery, recovery best practices, and success rate.
|
|
|
|
Post by Romy & Frankie on Sept 15, 2021 14:40:28 GMT -7
Welcome to Dodgerslist, Rob. We are glad you’ve joined us all. We’ve got valuable information we’ve learned from the vets Dodgerslist consults with and our own experiences with IVDD since 2002 to share with you! Learn more about us and how we team up with veterinarians: dodgerslist.com/about-team-dodgerslist/Disc disease is not a death sentence! Struggling with quality of life questions? Re-think things: dodgerslist.com/2020/04/18/hope-quality-life/
Dodgerslist work's with vets: dodgerslist.com/2020/04/20/education-team-ivdd
Ralph is likely to stay in the hospital for several days post surgery. My dog, Frankie was in the hospital for 5 days. Some dogs stay longer, some less long. The criteria for going home is usually when pain can be controlled with oral medications. When Ralph comes home, he will be on post-surgical crate rest for some time. Some surgeons prescribe 4 weeks of crate rest, some six and for more complicated cases some surgeons prescribe 8 weeks. PT will also likely be prescribed.
You will want to have everything set up for Ralph when he comes home. Here are some tips for the crate rest period :
Ralph will likely be sent home with some medications. The surgery will remove the disc material pressing on the spinal cord nerves and the pain that causes. Any pain now will be from the surgery itself. Here is some info on meds commonly used for IVDD:
Here are some special tips for care of neck disc episodes:
Those of us with larger dogs face logistical challenges when caring for our dogs at home. We can not easily lift them. I used a "help em up" harness for lifting Frankie. This type of harness is specifically designed to help support dogs during rehabilitation or dogs with disabilities and can support both the front and back parts of the dog.
When our larger dogs need to potty, consider using a large pee pad right outside the crate. This will save your back when lifting. I did this with my dog. At first he did not want to use it. I got a paper towel with another dog's urine and placed it on the pad, then he understood and started to use the pad.
It is impossible to tell how much recovery will take place and at one timeframe. Nerve heal slowly but they can and do heal. Since Ralph has DPS, this bodes well for future recovery.
When it is time for Ralph to be discharged, make sure you have all your questions answered. Here is a list of some starter questions: staging.dodgerslist.com/2020/06/03/discharge-day-list
It is scary when our dogs are diagnosed with IVDD. It becomes less so when we lern all we can about the disease. We have more information on our main website, www.dodgerslist.com. Use the search bar at the top to search for particular topics.
Healing thoughts for Ralph. |
|
|
|
Post by Rob & Ralph on Sept 15, 2021 17:45:15 GMT -7
Thank you, Romy.
Ralph is out of surgery as of 7pm today, 9/15. The surgeon said Ralph tolerated surgery very well, and the surgery went vert well. She said a lot of spinal disk material was removed, and that there was bleeding and bruising around the spinal cord, but that the pressure is fully removed and the spinal cord looked to be in good shape other than bruising.
I very much appreciate the links. I found this site via the Facebook IVDD support group and had visited the Dodgerslist site before but did not realize there was a forum.
I will be reading through all the material you shared, especially the link about neck specific episodes. My wife and I struggled to lift Ralph. We tried blankets, towels, the military harness, and nothing seemed to work well and also leave his anatomy free to function for urinating. I will be buying a proper lift harness and appreciate the info on those.
I can't tell you how grateful I am this site and the people in it are available as a resource.
|
|
PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
|
Post by PaulaM on Sept 16, 2021 8:06:24 GMT -7
|
|
|
|
Post by Rob & Ralph on Sept 16, 2021 8:56:50 GMT -7
I do have a question for post-op recovery, if this is a good place to post it.
We are concerned with :
A. How best to safely transfer him from a stretcher at the hospital to the back of our SUV, and then how to safely transfer him from the SUV to inside. I am considering trying to build sliding board of sorts out of wood, and sliding him into the back of the car, and then carrying him on the board inside. Am I overthinking it? Should he be able to be safely moved using a harness by the time he is discharged?
B. How best to do crate rest. We have another smaller dog, a cat, and 3 children, two of which are still young.
We are concerned mostly with our young children accidentally injuring or exciting Ralph, but interestingly Ralph and our cat are best friends and play all the time - I'm worried our cat will excite Ralph or make him jerk or move suddenly, etc.
Ralph is too large for my wife and I to safely get in and out of his normal crate. We looked at ex-pens, but need something with a top to prevent our cat from jumping in. We found a reasonably priced one online that has an optional metal crate material top cover. It seems to me the top cover will pull double-duty at keeping our cat out but also help keep the sides of the ex-pen from moving around. Does anyone have experience with ex-pens and top covers?
I really appreciate any specific information, advice, or suggestions.
|
|
|
|
Post by Hank & Augie on Sept 16, 2021 10:09:37 GMT -7
rob/ralph augie had the same type of surgery(he is 50 lbs). He spent 6 days in icu. his surgery was 6/9 as of today he is back to "normal". He is running ,playing and swimming( no ball jumping). He spent 2months in crate rest. He was able to pee/poop on his own (shaky at first). Just wanted to let you know there is light at the end of the tunnel. You can look at my thread to know what augie went through. dodgerslist.boards.net/thread/8072/hanks-augie-neck-surgery4wks-cattle GOOD LUCK |
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
|
Post by PaulaM on Sept 16, 2021 10:19:28 GMT -7
Rob, Ralph's thread is the exact right place to talk things about Ralph! While Ralph just had a major surgery, as my surgeon reminded me, your dog is not a China Doll. So just as a person who has had surgery needs to take it easy they can still move around. In fact many dogs can start controlled supervised PT right after a surgery. You can let us know more on discharge day what your surgeon directs for at home PT and for how many weeks he want post op rest to heal the surgical sites. Carry him if he can't ambulate at discharge time. Use a stretcher if that is how you can do so in safety for your own backs lifting a heavy dog. On discharge day Ralph may have some use of front legs and wobbly back legs. He may be able, with aid of a full body harness, to walk up a ramp to your SUV. Call the hospital and ask questions. There are commercial portable dog ramps designed to work with a vehicle. From now on Ralph should never use steps/stairs. Using a ramp eliminates impact to IVDD discs. When Ralph is inside the SUV, have an area padded out with rolled up blankets. Some sort of DIY divider (there are also commercial wire dividers) to keep him with just enough room to turn around and stretch his legs when lying down in back of SUV. CAT and other pets Option I did, if you don't buy the optional wire top for an ex-pen: Your local hardware store can cut (or if you are a DIYer you can cut) a piece of plexiglass to cover the top of the ex-pen. Drill some perimeter holes to secure to the wire ex-pen with tie wraps or such. At times to make the ex-pen feel cozy and den like for Ralph, drape a blanket over the top of the ex-pen. When you care for Ralph (suite maintenance, potty time, doing PT) you'll need to concentrate fully on Ralph and he does not need any distractions. So I would say kids and other pets should be in another room.
Set up a bed or blankets adjacent to the ex-pen so other pets can camp out there and just be near Ralph. Ralph would enjoy the company if no one is getting rambunctious. You will just have to see how that goes. CHILDREN IF your kids are of an age to understand that Ralph is in his at-home hospital (the ex-pen) and healing from a very big surgery, they may be able to control their behavior. They may be of benefit by helping Ralph with petting/touching through the wires and talking to him. Hope some of the these idea will help you out. |
|
|
|
Post by Rob & Ralph on Sept 17, 2021 8:38:03 GMT -7
Hank, Paula,
Thank you both for all the info. It is a lot to read through and absorb, but I think we can be prepared and have everything in order to give Ralph the best chance for recovery.
As an update, yesterday Ralph was still very groggy which surgeon said was expected 1 day post op. They planned to cautiously back off his pain meds. As of this morning his pain is still managed well, and he is much more alert.
[9/17] He still does not show movement in his front legs but his back legs are working. They plan to start conservative PT this afternoon. We are hopeful for a Sunday discharge as long as everything goes well.
Rob
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
|
Post by PaulaM on Sept 17, 2021 8:49:30 GMT -7
Rob, sounds like things post-op are going well for Ralph. Good to hear transitioning off of hospital meds to at-home pills is keeping pain fully covered.
|
|
|
|
Post by Rob & Ralph on Sept 19, 2021 19:25:33 GMT -7
Ralph came home today!
He likely could have stayed a little longer in the hospital, but we honestly could not afford another day. Also, he was not sleeping in the hospital.
He is able to stand while supported for a few minutes, but fatigues quickly. We did passive range of motion PT on his front paws today. He has the "tip-toe" effect in his front paws, which the PT said can be helped with early ROM PT. There was a fair amount of moving him around today between transport and getting him settled, so we did not do any PT with his legs, just his paws.
We are so grateful and happy to have him back home.
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
|
Post by PaulaM on Sept 20, 2021 11:28:08 GMT -7
Rob, most often dogs do have a better recovery at home in familiar surroundings. Sleep is very important for healing.
Does "tip-toe" in front paws mean he knuckles under the paw? Can he eventually put the paw correctly on the floor. Or not yet about righting his paw?
When you get a chance, do list out med names, dose in mgs and how often you give daily.
For how many weeks does the surgeon want for post-op rest in a recovery suite which would also include any directed at-home PT?
We look forward to your next update to see how things are going for Ralph since being home and also for you in caring for him.
|
|
|
|
Post by Rob & Ralph on Sept 21, 2021 17:57:58 GMT -7
It has been pretty hectic getting everything in order, but I think we have a good rhythm now.
His tip-toe is more of a stiffened paw, like he is walking on the pads of his toes, and not fully planting the "heel" of his paws. His paws will flex just fine during PT, but when he actually walks it's like his automatic response for now is to "tip-toe". The physical therapist said this will diminish with PT and as he recovers.
Gabapentin - 300m, every 8 hours or as directed.
Codeine - 60mg, every 8 hours until gone.
Amantadine - 100mg, every 24 hours until gone.
Diazepam - 5mg, every 8 hours until gone.
Prazosin - 1mg, every 8 hours or as directed until gone.
Clavamox - 250mg, every 12 hours until gone.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
75-80lbs 5 y.o.
surgery 9/15
gabapentin 300mgs 3x/day
codeine 60 mgs 3x/day
amantadine 100mgs 1x/day
diazepam 5 mgs 3x/day
Prazosin 1 mgs 3x/day
clavamox 250mgs 2x/day]
For how many weeks does the surgeon want for post-op rest in a recovery suite which would also include any directed at-home PT?
We are to have a follow up in 7-10 days and were directed to do the following until then:
Massage - 5 to 10min 3-4 times a day
Passive range of motion - 10 to 15 reps 2-3 times a day
Assisted Standing - 3 to 5 minutes 3-4 times a day
Weight Shifting - 6 to 8 reps 2-3 times a day
Well, Ralph is doing phenomenal.. I am afraid he is doing too well and is not taking it easy enough. We keep him crated when he is not eating or taking a potty break. We need to help facilitate him standing when he has been in his crate for a long time, but once he is standing he can walk out of his crate with assistance. We need to help place his feet on the soft bed material but once his front paws are on firm carpet or a yoga mat we have covering the hardwood floor in front of his crate, he can walk on his own. We have it set up so that he needs to take about 3 steps to reach his food and water which are elevated so he does not need to bend his neck.
What has me worried is potty time. During potty time he would be content walking for a very long time. The discharge orders state that he should be walked for 5 minutes or the time it takes for eliminations 3-4 times daily, but Ralph would be content walking for 15 or 20 minutes without eliminating if he had his way. He tries to pull us around actually (which he never did before, he was very well leash trained). We think he is sick of his crate already and tries to spend more time walking outside.
I am afraid of overdoing it with him, but I also don't want to limit his movement any more than necessary to allow him the opportunity to regain stability and muscle at the pace he is ready to.
Should we be strictly limiting his walks to 5 minutes and taking him right back to his crate if he does not eliminate?
|
|
PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
|
Post by PaulaM on Sept 21, 2021 19:51:18 GMT -7
Rob, it is always the case as dogs begin to feel better they are more of a challenge to ensure they have good opportunity to heal all the surgical sites. They don't understand Drs orders to take it easy! His back legs work. What is the current situation with his front tip toe legs? Are the front legs now moving in a walking motion...do you need to use a front end sling? Would you be able to set up a temporary fence of sorts in the grass to give a small area he can walk in for potty time? The physical of the fence would let Ralph know there is not going to be any sniff festing, darting after something, or long walks, etc. If he can walk with front legs as well as back legs and no sling needed, you would only need the leash connected to the harness for the walk to get to the fenced in potty place. With our little dogs, an ex-pen in the grass for the potty place works great. Not sure what is available at your hardware store that might serve as a temporary measure for potty time. For how many weeks does the surgeon want for post-op rest to allow all the, bone, muscle, etc involved in the surgery time to heal? You could call the surgeon to verify if Ralph needs to follow the strict 5 min potty time or is there leeway for some extra minutes? |
|
|
|
Post by Rob & Ralph on Sept 22, 2021 11:08:10 GMT -7
Thanks for all the replies, Paula. The information is really valuable.
So, Ralph is back and forth. He is not always able to get up on his own. Sometimes he tries and flops back down, and other times he can pop right up and walk out of the crate. When he is walking outside, he starts out a little shaky with his front paws knuckling. We have to place his paws for him, but then all of a sudden he takes off and walks pretty well. It is unpredictable whether his next steps will be good sturdy ones, or if he is going to buckle or his paws are going to knuckle.
We do need to use a front and a rear sling. His back legs are much better than his front, but both his front and back legs do go weak and buckle. Also, during the short walks he will stop and lean on us to take a break - sometimes we need to keep a good grip on the slings because while resting his legs sometimes buckle.
After any amount of time walking, he is visibly exhausted though and lays in his crate. He is not restless in his crate. He gets up for the occasional re-position, but other than that he is laying down on his side.
We will call the vet to ask about his walks and if she thinks he should keep going like this or slow things down.
Robert
|
|
|
|
Post by Romy & Frankie on Sept 22, 2021 13:16:56 GMT -7
Recovery from IVDD surgery is not linear, so it is not surprising that Ralph has his ups and down.
Although walking should tire him out, exhausted seems a bit much. It is only about a week post-surgery, so getting input from the vet as to how much walking he should do is definitely a good idea.
|
|
