Gwynne's Rio 2/9 surgery4wks - Terrier mx CANADA; GRAD 3/9

Gwynne, welcome! We are glad you are here. Love  the neuro report you gave...it means Rio's body is  doing an awesome job of self repairing nerve damage!! Nerves usually are a slow thing to repair. Often it takes adjusting to thinking more in terms of months rather than days/weeks for this slowest part of the body to heal. Yet, Rio has started the process rather quickly!

Surgery 2/9 with no deep pain sensation (DPS)
1. 2/10 ➡️ Deep Pain Sensation: the first neuro function to return. DPS is the critical indicator for nerves to be able to self heal after surgery. 
2. 2/15 ➡️ Tail wagging with joy at seeing you or getting a treat or meal.
3.    ?    Bladder control verified with the "sniff and pee" test.
4.          Leg Movement, and then
            ability to move up into a stand 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.

After ability to do a happy tail wag, then the next repair of nerve function will  be bladder and bowed control.  The use of a catheter prevents learning if your dog has bladder control. Most often dogs are send home with owner lesson on how to manually express the bladder.  Either go to the surgeon or your own local vet to get a hands placed over your hands expressing lesson. [🔎WATCH expressing video/tips] first to get more from the lesson. With the catheter out, you can then proceed to give the sniff and pee test.

SNIFF and PEE test
The only way for humans to know if there is bladder control is with the “sniff and pee test.”
    Carry outdoors, set them on an old pee spot to sniff.
    Make sure the sling or your hands are not on the tummy area as that can press on the bladder.
    See if they will release urine on the old urine area.
    If urine comes out after sniffing, bladder control is returning. You should continue to do a quick express check to verify there is full voiding until you are certain it is consistently happening. Let us know what you observe.
    NOTE: When the bladder is full, it fills the entire abdomen area so any pressure should release urine if bladder control is not yet back. You may need to hold the pressure for a little longer than you think you would. As the bladder empties, it gets smaller and can slip away from you. You’ll need to find it again. Sometimes it moves back by the pelvic area. Keep pressing until the bladder feels flat, almost like your hands are touching.

POTTY TIME SAFETY
    Carry to and from the recovery suite to the potty place outdoors and then allow a very few limited footsteps.
    Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog’s back aligned and butt from tipping over.
    A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot.
    An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on!

dodgerslist.com/wp-content/uploads/2020/04/Potty-leash-harness400-19kb.jpg **

Just trying to throw out some ideas and get a feel for your family situation.
    Is it possible if you youngsters are cared for at home, that person, could help with expressing?
    Does another member of your immediate family have a different work schedule than you do?
    Maybe that person can help with Rio's care? A neighbor you could hire?
    Who gives gabapentin 3x/day? Could that person help with Rio's potty care?

EXPRESSING FOR POOP
Often control of poop will many times come back about the same time bladder control starts to return.  Dogs who do not yet have control of poop, can be expressed manually.  
    Poop expressing is to prevent anxiety of finding poop where they sleep. 
Expressing for poop should take place before mother nature would just let it plop out anywhere. You get there first to encourage poop to clear from the digestive tube to plop out where you desire.
    Most of us express for poop on the toilet: upon awaking in the morning, maybe at 1-2 pm during the day and again before bedtime. First you should make a chart of eating, poop plopping times and try to figure out when you should be expressing. You really do not need anyone to demonstrate how to express for poop. This video shows how easy it is. Read more tips here:

DIARRHEA, not eating
-- Has there been any change in food that would account for loose stool?
-- Any black or red blood in the diarrhea?
-- Catheters could cause urinary tract infections. UTIs can make a dog feel pretty crummy.  When is the last time she has had a urinalysis to prove there is no infection going on?
-- Gabapentin for nerve pain has listed as possible side effects:  nausea and diarrhea. Alert your vet/surgeon to this new observation.  Do you give gabapentin with a meal or some food to help with nausea? 

POST-OP rest 
After the surgery many times the length of rest to allow the surgical areas to heal is 4 or even 6 weeks.  What does  "Feb 15 - after crate rest"  mean?

Rio seems to be on a pretty good path of healing. Depending on your feedback, we look forward to other thinking outside the box ideas to help you with poop/pee care if you need 'em.

Gwynne, did you see the tips to charting timing and when to express for poop?  dodgerslist.com/2020/05/05/bladder-bowel-care#poop   As long as there is diarrhea, timing would be quite difficult.

What is the status now on diarrhea, loose stool... any signs starting to firm up?  

DIARRHEA
Getting to the root cause of diarrhea (gabapentin caused, other?) is something you should discuss with the neuro today.  Also discuss about using pumpkin to help firm feces.

PUMPKIN
     Plain pureed canned pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation.  NOTE alternatives: microwaved and mashed peeled sweet potatoe,
  --To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day.
  -- To firm up the stool add once a day 2 teaspoons  plain canned pureed pumpkin to kibble for your 18lbs dog.

Let us know what the neuro says today re:
--how many weeks does he want for post op rest?  It can vary depending on the dog's case--  often it is 4 weeks, but can be 6 weeks.  After the rest weeks are over, then starts a very slow and gradual intro back to physical activity and family life.  We'll have lots of things to share with you when we know the date of graduation.

Bathing may not be the safest idea during the rest period. You know slippery wet dog, big body shaking to get water off, etc.

This tip and many other good ones comes from:
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.  A spritz  removes the odor... good on linens, floors and other hard surface. 

DIAPERS
Diapers are more of a last resort thing...  They can cause problems of body waste on the skin (infection, rashes). Cause the dog anxiety of smelling poop/urine collected in the diaper.  There is a very short path for bacteria from anus to get into the bladder for a female dog and development of urinary tract infection (UTI). 

As a last resort, while learning to express (if proved you need to express after cath is out), the commercial diaper products have better absorbency properties than a cloth diaper.  Not sure what your cloth diaper is...just a covering to hold a absorbent pad or what? Can you describe?   Probably best is just let a well-formed normal poop plop out and not be stuck in a diaper.  

Diarrhea is a messy situation.  Commercial baby diapers may do a better job of absorbing, as a temporary last resort until diarrhea clears. 

Gwynne, report sign of pain now to your local vet or the surgeon. Have absolutely no patience with pain.

Seeing more than one sign of pain helps to confirm pain that needs pain meds adjusted.  There is more than one source of pain.
Gabapentin is for nerve pain
traMADol is for overall pain
methocarbamol is for muscle contraction pain.

Let us know what your vet says/does about the pain you describe.

Trying to stand is a good sign. The fact that trying to do this makes her back end shiver is likely due to weakness. If she is not shivering at other times, it is probably not a sign of pain. When we are not sure if something is a sign of pain, we can look for an additional sign to confirm. I will put the signs of pain again here, so you can easily reference them:
- shivering or trembling
- yelping when picked up or moved
- tight tense tummy
- arched back
- restless, can't find a comfortable position
- slow or reluctant to shift positions or move in the crate
- just not their normal perky selves

Gwynne, Wowee, classic order of nerve healing happening!!!! YEAH Rio, you are on a roll!!!!

I bet she does have bladder control returning

Surgery 2/9 with no deep pain sensation (DPS)
1. 2/10 ➡️ Deep Pain Sensation: the first neuro function to return. DPS is the critical indicator for nerves to be able to self heal after surgery.
2. 2/15 ➡️ Tail wagging with joy at seeing you or getting a treat or meal.
3.  ?   Bladder control verified with the "sniff and pee" test.
         Cath does not come out til 3/2
4. __  Leg Movement, and then
   2/25 ➡️ ability to move up into a stand 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.

Spot cleaning better with green tea than soaps.

Use unscented baby wipes for quick clean ups. 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.

i.postimg.cc/rp9HtMR1/Dog-care-TIPS-400.jpg **

Very good news about Rio! Standing by herself and peeing and pooping outside. If she can "sniff and pee" and is able to hold her bladder and bowels until she is outside, she has control. This is a big step forward in healing.

Many surgeons prescribe 4 weeks of crate rest and afterwards a slow return to activity. Four weeks is not unusual for post-op crate rest.

It is quite soon after surgery and it seems as if Rio does not have complete control but is regaining it. This is not uncommon. Bowel and bladder control usually return about the same time, but not always. My dog Frankie regained bladder control months before he regained bowel control.

Since she does pee outside, give her plenty of opportunity to go outside for pottying. After she goes, you can make sure her bladder is completely empty by giving a quick express check.

It is possible that she has a UTI, since catheter use is sometimes related to UTI's. You can bring a urine sample to your vet to check for bacteria, and then you will know for sure. But since she has had poop accidents as well, it is likely that she does not yet have complete control.

Good morning,

Rio had her first PT session yesterday. Right before the session she [3/7] started to use her back legs a few times while she was assisted on her special harness. She continued that at the PT session and she started kicking her legs when annoyed  . All great signs! Today she is very tired from all her exercise yesterday. 

My only concern is she continues to have no control over her bladder or bowels. I keep taking her out and she has no interest in being outside (where she used to love it), she is almost anxious about going to the washroom... I have contacted the neuro again as she was allergic to Prazosin and needed to stop but I am wondering if there is another drug that can help. Not sure if you have any thoughts on this?

[MED LIST/HISTORY- Moderator's Note. Please do not edit
18 lbs 3 y.o.
2/15 wags tail
gabapentin 100 mgs 3x/day
cath removed 3/2]

Thanks

Hi There,

Quick update on Rio, she has gone to the bathroom outside quite a bit. Dribbling in her diaper when indoors and pees when she is excited... so work in progress I hope

As for her legs, she is getting stronger every day. She goes to PT once a week and is doing assisted walking with her [Help 'em Up Harness] special harness

Sorry I made a typo above (now fixed) which was misleading... she is peeing outside a lot. Seems that she is regaining control of her bladder but not perfect yet. When she pees she trys to squat but is unstable a bit so she fumbles a bit which interrupts her. So she does a bit of a squat and drag with her front legs. As for poop she has had some accidents when she needs to go in the night. I think she is trying to tell me she needs to go though but I am too sleepy to pick up on it. 


-- [ sniff and then choose to release urine?] Yes, and sometimes she is walking and just squats... but either way it seems intentional
-- She is using the help up harness and I don't believe there is too much pressure. But if I were to pick her up and press on her tummy with a full bladder I would expect a dribble
-- [leak on you when lifted?] Not unless I were to press her tummy

[hold poop in, until in an appropriate spot such as outdoors?] Mostly

-- under water treadmill? Not yet
-- swimming? Not yet
-- Just exercises.. but I go again tomorrow so I expect something new

Hi There,

Rio had her first hydro treadmill session today March 15. They said she has made great progress this past week.
She is now out of her crate but needs to be watched to avoid slipping and jumping 24/7. They have also said she can extend her walks to 5-10 mins twice a day. She has PT every week for the next two months at least.

I am still concerned about a UTI. I had them test her urine on March 13 but it was inconclusive. It didn't show bacteria but her white blood cell count is up and she has mucus in her urine. I collected the sample myself. They tried at the vet today March 15 to collect a sample but weren't able to. I will make an apt for March 16 to retest. Will let you know how that goes.

Thanks for your help as always!

Hi there,

Sorry if I’m not commenting correctly. Rio has now had a few months under her belt. She is walking and has bladder control and is very happy. But still I worry. The Doc told me there is a 30% chance of recurrence and lately I am concerned.

Rio is having difficulty with her bowel movements. She doesn’t always have control. This could be because she isn’t very strong in her hind end and cannot expel 100%. This could also be because it is returning. Curious what are the signs of recurrence.

Thanks in advance