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Post by Aimee & Lenny on Feb 27, 2022 13:52:52 GMT -7
[Original subject line: New Recovering Conservative Back ]
QUESTIONS
☆ 1 Is there still currently pain? sometimes
/ Arched back
/ Not their normal perky selves?
2. 19 lbs Age? 7
A..Prednisone 5 mg - 1 tablet every 12 hours. Started 2/19/22 - given shot at ER then started on oral in the evening 5 mg every 12 hours
taper? not yet
Gabapentin 250mg/5ml - 0.8ml 2-3 times a day (currently just twice a day)
Methacarbamol 500 mg - 1/4 tablet 2-3 times a day (currently just twice a day)
Omeprazole 20 mg - 1/2 tablet once a day
[MED LIST/HISTORY- Moderator's Note. Please do not edit
19 lbs 7 y.o.
Prednisone shot 2/19 a.m.
prednisone as of 2/19: 5mgs 2x/day for ? days, then a test taper for: _pain / _neuro
gabapentin 250mg/5mL: 40mgs (0.8mL dose) 2x/day
methocarbamol 125mgs 2x/day
omeprazole 10mgs 1x/day ]
Currently on Omeprazole. Is Pepcid AC better than Omeprazole?
☆ 3 -- List any red flag signs of stomach damage.
None
☆ 4 What breed? Long haired dachshund. Your dog’s name? Lenny. Your name? Aimee
☆ 5 Was the diagnosis IVDD (aka: a disc problem, a disc herniation, a bulging disc, slipped disc)? Yes
-- Is the vet a general DVM? ER vet
☆ 6 What was the date you saw the vet for CONSERVATIVE treatment? ER on 2/19/22
☆ 7 Can your dog specifically sniff and squat and then release urine which is bladder control? Can release urine when legs are supported.
☆ 8 Unable to walk, moves right leg more than left leg but not enough strength to stand, wags tail
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Feb 27, 2022 16:33:36 GMT -7
Aimee, welcome to the Dodgerslist IVDD Care and Support Forum! IVDD is all about healing the disc with conservative treatment. A damaged disc can impact nerve function as what happened with Lenny. Calm your mind about nerve healing, know the facts: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/ Calm your fears: dodgerslist.boards.net/thread/410/living-fear-ivdd PAIN If you are observing that Lenny is in discomfort, then give the two pain meds promptly every 8 hrs. These meds (gabapentin and methocarbamol) only last in the body for about 8 hrs. So every 12 hrs generally does not keep a dog in full comfort from pain. IF pain continues to still show, then alert your vet. Advocate that all sources of pain be covered every 8 hrs.: √ Gabapentin deals with nerve pain √ Methocarbamol deals with muscle contraction pain __ traMADol 3x/day is the general analgesic. PREDNISONE anti-inflammatory ? days course For how many days is Lenny to stay at the anti-inflammatory level of prednisone (5mgs 2x/day)? This is the page to have a full understanding on how prednisone is used during a disc episode. Good background info to discuss and ask questions of your vet.https://dodgerslist.com/2020/04/18/steroids-vs-nsaids/
OMEPRAZOLE vs. PEPCID AC
Since he is on omeprazole now over 3 days, stick with it. This is another good page to have under your belt about the "why's of stomach protection and which to choose: dodgerslist.com/2020/05/06/stomach-protection/
Lenny has a good chance to heal his disc by following STRICT rest. And with time, that leg nerve damage, too, can heal to bring back walking. The key is to follow STRICT REST principals.
-- Set up his recovery suite to make the next 8 weeks of rest go smoother dodgerslist.com/2020/05/14/strict-rest-recovery-process/
-- Making sure you are following the Conservative Treatment ROADMAP. This really helps you to avoid dangerous detours when you understand the plan of treatment, the healing, the time frames, etc.
VIEW, DOWNLOAD and print: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf
--Anytime out of the recovery suite is a danger to the early healing disc. Let us know you are being super cautious at potty time:
Carry to and from the recovery suite to the potty place 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/snow 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 **
Other than suspicions of not in full comfort from pain that you can remedy with gabapentin and methocarbamol 3x/day dosing, sounds like Lenny is going to have a very good chance to heal his disc and work on healing the back leg nerve damage too.
Let us know what date will pred start the taper down from the current 5mgs 2x/day. The taper date is very important and we want to be ready to support you in your monitoring.
Is there anything else that's been concerning you, we could help with? |
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Post by Aimee & Lenny on Feb 27, 2022 21:21:17 GMT -7
He had follow up with our regular vet yesterday 2/26/22 as instructed by ER vet to refill meds. He is clueless with how to proceed. He recommended we take Lenny to the UW Madison Vet School (1.5 hour drive for us) for specialized care since there seems to be no vets in our area that deal with IVDD. I will be calling tomorrow for consult. So we don’t have any real vet guidance at this time. We are following everything recommended at this site for conservative treatment. Grateful for the support here.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Feb 28, 2022 10:38:49 GMT -7
Aimee, so sorry your vet is not one who has a degree confidence in their knowledge of IVDD. This is why he has referred you to a higher authority. A consult with a specialist is not just for the purpose of a surgery, but when your local DVM vet is not comfortable with their knowledge of IVDD and meds. Unfortunately it means taking a risky to the healing disc transport into UW Madison. Hopefully your vet will then have some courage to contact this colleague when he has a question. My local vet never hesitated to phone a colleague to get up to date information for my dog, this is what good vets do. This makes it all so much more important that you get up to speed on conservative treatment. You'll need that knowledge to hire the right vet to be on Lenny's IVDD health care team. Knowledge will stand you well in being able to ask the right questions, offer ideas and be able to identify when well-intentioned but harmful advise is offered.
Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with IVDD. Each of us needs to be self educated so we can team up to work with our vets. "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!" READ MORE: www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdf Elements which make conservative treatment work for many disc episodes ➤ What to expect during each phase of healing: dodgerslist.com/in-the-right-place ➤ Surgery vs. conservative, when, risks, etc. dodgerslist.com/2020/02/10/surgery-vs-conservative/Conservative treatment is not rocket science. STRICT REST is what is takes for at home care However, you will need to have the supervision of a vet in the use of the hormone Prednisone. This steroid needs to be tapered in an exact way to signal the body to make its own steroid again. No one knows how long to use prednisone to get swelling down. Therefore it is prudent for a vet to Rx an anti-inflammatory level course for 5-7 days or maybe 14 days and then taper. The taper is also a perfect window of time for you and the vet to know if all pain is gone, if prednisone can continue to the final taper dose. OR if pain surfaces, then clearly another course of pred would be needed with another taper. - Date when pain meds run out? - For how many days is Lenny to stay on the anti-inflammatory level of 5mgs 2x/day?-- Will the ER vet refill? |
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Post by Aimee & Lenny on Mar 3, 2022 20:27:30 GMT -7
This has been a very stressful and frustrating week. The UW Madison Vet School is more than willing to help us but they can't get us in until end of May unless we go through the ER which would cost us more. They recommended we tell our vet to reach out to them or check with another hospital in another town that has a Neurologist. They too are fully booked unless we go through ER.
So I am calling around for vets in our area with IVDD experience and so far has been unsuccessful.
On top of that, the medications given to us at the ER needed to be refilled. Our regular vet was able to refill the Prednisone but he did not have any Gabapentin and Methocarbamol at his clinic. So he told us to order thru his online pharmacy. The online pharmacy had the Methocarbamol but the Gabapentin dose they had was different from what was prescribed at the ER. So I had to wait until Monday to clarify with our vet since they were closed on Sunday.
He [my vet] sent me an email order for ▲Gabapentin 100mg/ml.
The dose given to use at the ER was 250mg/5ml. I have medical background and I'm quite sure this is not the equivalent dose but I am not a doctor or a pharmacist. I just agreed since we were running low and shipping can take up to 2 days after processing.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
19 lbs 7 y.o.
Prednisone shot 2/19 a.m.
prednisone as of 2/19: 5mgs 2x/day for ? days, then a test taper for: _pain / _neuro
gabapentin 250mg/5mL: 40mgs (0.8mL) dose 2x/day SToPPED
gabapentin 100mg/1mL: ▲250?mgs (2.5ml ) 2x/day
methocarbamol 125mgs 2x/day
omeprazole 10mgs 1x/day ]
When the [GABAPENTIN] medication arrived today, the instruction was to give him 2.5ml 2-3 times a day.
Lenny has been taking 0.8-1.6ml 2-3 times a day at the 250mg/5ml dose. If I give him 2.5ml 2-3 times a day of the 100mg/ml dose I think I would be giving him too much and might cause him to be too sedated.
So I am planning on just giving him 0.5-1.0 ml of the 100mg/ml.
If there's anyone who is able to understand the difference with the dosages, please let me know if this is making sense or not. I do not know who else to talk to. I am frantically searching for a new vet but I'm afraid even if I find one we won't be seen right away since all the vets seem to be fully booked.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Mar 3, 2022 20:56:47 GMT -7
ER prescribed:
gabapentin 250mg/5mL (50mg/1mL): 200 mgs 40mgs(0.8mL) dose 2x/day
50mg/mL X 0.8mL = 40 mgs (0.8mL dose)
Your vet Rx'd Gabapentin : gabapentin 100mg/1mL: 250mgs (2.5mL ) 2x/day
100mgs/mL X 2.5mL = 250mgs gabapentin (2.5mL dose) 2x/day
"So I am planning on just giving him 0.5-1.0 ml of the 100mg/ml."
100mgs/mL X 0.5mL = 50mgs gabapentin (0.5mL dose)
100mgs/mL X 1.0mL = 100mgs gabapentin (1.0mL dose)
Let us know for how many days prednisone REFILL 5mgs 2x/day was Rx'd, then a taper.
Hope your vet will do what good vets do. They confer with colleagues. UW Madison extended the offer!!!! Your vet should be telling you he's calling UW Madison.
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Post by Aimee & Lenny on Mar 3, 2022 23:34:25 GMT -7
ER Prescribed Gabapentin:
250mg/5ml and not 250mg/ml. The tricky part is the per 5ml vs just ml. So I think 250mg/5ml is actually equivalent to 50mg/ml.
50mg/ml x 0.8ml = 40mg
50mg/ml x 1.6ml = 80mg
If I give him the 250mg with the new prescription then it would be more way more than double the max of what was prescribed before. I’m scared he won’t be able to stay alert to even eat and go potty.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Mar 4, 2022 7:56:01 GMT -7
You are correct Aimee ER's formula was 250mg/5mL (same as 50mg/1mL). There should be a vet on duty at UW Madison to confirm or your vet will be open this am.
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Post by Aimee & Lenny on Mar 18, 2022 9:30:41 GMT -7
Update on Lenny:
We finally were able to get Lenny seen by a vet this week with experience with IVDD. Such a relief after frustrating issues with meds and follow ups with previous vet.
He is now being [date of 3/19?] tapered off of Prednisone. He is at 5mg daily for one week then 5mg every other day until our supply runs out which is about 2 and a half weeks. He continues with ▲Gabapentin at 50mg twice a day (0.5ml of 100mg/ml twice a day) and Methacarbamol 1/4 tablet twice a day for a week then taper to once a week. Continuing with Omeprazole 1/2 tab of 20mg daily until our supply runs out.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
19 lbs 7 y.o.
Prednisone shot 2/19 a.m.
prednisone as of 2/19: 5mgs 2x/day for 18? days, then 3/19? test taper for: _pain / _neuro
gabapentin 100mg/1mL: ▲50mgs (0.5ml ) 2x/day; backs off 3/27
methocarbamol 125mgs 2x/dayl backs off 3/27
omeprazole 10mgs 1x/day ]
He is not in pain. Getting anxious now with wanting to do more. Tries to get out of crate by pawing at the gate and biting the latch. We now have a stroller for when we’re at home so he can be closer to us. Still carried out and in for potty and sleeps in crate. No change with his functions- still not able to walk or stand on his own, has bladder and bowel control, able to wag tail. New vet wants us to continue crate rest and set up PT consult in a couple weeks. [PT Apr 2?; Graduation day not til Apr 17]
Need help with keeping him safe when we are at work and he’s in his crate alone. I’m afraid he’ll hurt himself trying to get out.
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Post by Romy & Frankie on Mar 18, 2022 14:15:19 GMT -7
I am glad that you were able to find an IVDD vet. It is so important to have a vet familiar with this disease.
Keep an eye out for any signs of pain emerging during the taper. Any pain would be a sign that more time on the full dose of pred and pain meds is needed.
As our dogs start to feel better, they often get restless. They think they are fine and just want to get on with their usual activities. We have some tips on calming in the crate here:
If you give these tips a try and they are just not working, you can speak with your vet about prescription sedatives like Acepromazine or Trazodone.
Physical therapy should not be started during the 8 weeks of crate rest. It is inactivity that allows the disc to heal. Since he can move his legs in the crate, no additional therapy is needed right now.
Once crate rest is over, we can point you to some exercises to do at home in addition to any prescribed by the physical therapist.
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Post by Aimee & Lenny on Apr 18, 2022 19:14:03 GMT -7
Lenny completed 8 weeks strict crate rest yesterday. He had his first PT session on 4/8/22 where the PT vet did a thorough assessment, did electroacupuncture and laser treatment. They also tried him on the water treadmill but he did not do any purposeful steps. The PT vet showed us range of motion, PNF walking, massage, standing and proper sitting activities to do at home. With her assessment, he has delayed DPS, absent superficial sensation, has tone but no purposeful movement in his hind legs. We go back for PT on 4/22/22. He is completely done with Prednisone and Methocarbamol but still on Gabepentin 50 mg twice daily. [MED LIST/HISTORY- Moderator's Note. Please do not edit
19 lbs 7 y.o.
gabapentin 100mg/1mL: 50mgs (0.5ml ) 2x/day ] His regular vet did give us Trazadone as needed for anxiety but we have only had to use it 3 times in the past 3 weeks. He's been more calm since we've been moving him around in the stroller to be closer with us. I just wanted to find out if there's anything else we can start doing with him. Is he allowed to spend some time out of his recovery suite now or is it possible to make his space a bit bigger so he can move about a little bit more? Also, do you have any recommendations for a car seat or booster? We have been putting him in the crate when we transport him to the vet and PT but he's low in the back of the van that adds to his anxiety. Thanks for all the info and all the help! |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 18, 2022 21:41:36 GMT -7
Aimee, I'm relieved to hear Lenny dodged a bullet and there were no setbacks (pain, re-tear of the disc) and now Lenny has graduated. GRADUATION, A SLOW RE-INTRODUCTION Determine how you are going to ease back into more normal activity at graduation from rest. The idea is to gradually give more freedom under controlled and supervised conditions. Not free riegn of the house and yard immediately! LOL Your dog's muslces are soft and out of shape after the rest period. Gradually build up their muscles and their lungs. Take a look at our information. Gradually building your dogs muscles over a month's time will have your dog safely moving about the house and outdoors to have fun again! SAMPLE SCHEDULE Here is a sample schedule to safely and slowly introduce your dog back to family life and physical activity: dodgerslist.com/2020/06/15/back-friendly/?highlight=sample%20scheduleWHEELCHAIR Is there thought to getting Lenny a wheelchair while waiting on more nerve healing to take place if it fits your budget. That way he could use the cart as a PT device with legs down when nerve self repair enough. In the meantime he can feel in control and enjoy rolling outdoors to all his regular stops and feeling the wind flapping his ears. More on features to look for in a cart for an IVDD dog: dodgerslist.com/2020/06/06/wheelchairs/HAPPY DAYS AHEAD 1) You and your dog have survivied a disc herniation! Learn what you can do from this point forward, how to handle dentals, trimming nails for traction. Lots of ideas and tips in living with an IVDD dog: dodgerslist.com/living-with-ivdd-tips PT THERAPY AT CLINIC or HOME Safety first. You should always consult with a veterinarian before starting any exercise program with your dog. For example, although older dogs need to stay limber, arthritis might make certain movements inappropriate. - At Home Water therapy: dodgerslist.com/2020/05/28/surgery-dog-water-therapy - At home daily massage and range of motion. 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. - After conservative treatment of 8 weeks to ensure the disc has healed, it is now safe to begin daily at home PT.
GARMENTS TO PROTECT when scooting at home You will want to consider how you will prevent rug burns from scooting and protecting bacteria from entering the bladder. (UTI). Here are some sew and no-sew options: dodgerslist.com/2020/06/13/garment-skin-uti-protection/ ** i.postimg.cc/6q8Cm3b6/garment-opitons.jpgIt is still early in the nerve healing department. Think more in terms of months rather than days/weeks for this slowest department of the body for healing. i.postimg.cc/wMVBnDcY/Never-give-up400.jpg **HOME MODIFICATIONS See if your home is adaptable to make things easier for Lenny. -- You can easily make a screen curtain for your slider door with a curtain rod tension bar and a pkg of screen material from the hardware store. Hand sew a pocket for the tension bar. Add a bit of weight at bottom of curtain with a length of chain. A few pieces of left over linoleum might be free from the rug store for the doorsill and some for the deck. See how a dog can enjoy freedom to go in and out on a nice summer day. A perfect summer day is when….. As Helen Keller says "When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has opened for us." This pup didn't waste a moment finding the other open door. He loves life and and enjoys every moment. It's not the manner in which you get from point A to B, it's that you CAN get there. Teach Lenny how to go down a ramp. He can enjoy sitting with you and have a safe way to glide down the ramp when he needs to check for food in the kitchen or a sound at the door. What are the credentials of the PT veterinarian in order to assess her ability to correctly identify DPS? DVM, any other acronyms? Did you get a written report from the PT person? Has Lenny now lost bladder control and the ability to do a happy tail wag? 1. _√_ Deep Pain Sensation (DPS): the first neuro function to return. DPS is the critical indicator for return of further neuro functions. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about this very tricky to correctly idenfiy neuro function.2. 2/27 Tail wagging with joy at seeing you or getting a treat or meal.3. 2/27 Bladder control verified with the "sniff and pee" test.4. 2/27 hind leg movement, and then ____ ability to move up into a stand position, and then ____ wobbly walking.5. ____ walk with more steadiness and ____ Not knuckling paw under, properly places the paw6. Ability to walk unassisted and perhaps even run. LEARN MORE: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/During the 8 weeks of disc healing where strict limited movement is needed, on April 8 the PT person risked damaging an early healing disc by putting Lenny on the water treadmill?
What do you observe re: any movement the back legs can make. Exclude any leg action during potty times as those are likely reflex.
What is the purpose for gabapentin? |
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Post by Aimee & Lenny on Apr 19, 2022 15:50:42 GMT -7
Thank you so much for all the helpful information! We will definitely go slow with progression of his activities but it gives us hope that we will now have something to look forward too. It's been a long, slow 8 weeks!
The PT vet did give us recommendation for wheelchair cart. She does not want it started for another 2-3 weeks. We will look into it now so we can figure out what will be best for us. I actually also wanted to get your opinion if it's not too early to start him on it.
The PT vet's credentials are DVM, CCRT, CVAT. We got a written take home instructions. They did say they will send report to our regular vet too. Lenny still has bladder control and continues to have happy tail wag but inconsistent. He does it when his tail is straight out but most of the time it gets stuck curled up underneath him.
We don't see him moving his legs on purpose. He does withdraw his leg to toe web pinching, left stronger than right.
I guess we're continuing Gabapentin for nerve pain with nerve regeneration?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 19, 2022 16:03:38 GMT -7
Aimee, if you have the ability to scan, or snap a jpg of PT report, could you upload it?
No sense to be taking meds if t here is not a purpose for them. Ask about stopping gabapentin. Nerve healing is not painful.
It takes about 2 weeks for a cart to be custom made specifically for the measurements of the dog. During those two weeks you can work with Lenny on a slow progression of getting back to activity so he then is ready to to begin a slow intro to the wheel chair.
Everything is a slow introduction so there are no sore muscles. One doesn't want to be confused between benign sore of overdoing things, vs. is this another disc episode? Right!?
As your time permits, we'd really like to hear how Lenny is progressing not just with muscle strength and neuro advances, but to hear about what kinds of things he's doing to enjoy life and his new normal routine.
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Post by Aimee & Lenny on May 15, 2022 19:28:00 GMT -7
So many wonderful things have happened since I last posted it truly is amazing how the strict conservative treatment worked.
During week 9 all medications were stopped and Lenny had another electoacupuncture treatment done in a supported standing position. After 3 days, his tail wag got higher and faster and his right leg started having more motion that he was trying to scratch his ear with it.
On week 10 we got his wheelchair. He first tried going on his wheelchair on 4/28/22 and he immediately loved it. He was just on it for about 5 minutes to take pictures so I can send it back to Walkin Wheels to check on proper fit. The following day, after we made recommended adjustments and put him on it, we noticed he was actually moving his legs alternately like walking. He also started doing the "walking" with his hind legs while in the sling when going potty after that.
During week 11 he started standing up by himself. By the time we went back to PT on 5/5/22 he was able to stand up by himself consistently and maintain standing on his own and take a few wobbly steps. He still only did electroacupuncture per our request since it seems to be what's working the most for him. The PT also showed us balance and core strengthening activities to do at home like standing on books and on a wobble board.
After 2 days, he started walking on his own, although wobbly and sometimes does the bunny hopping when he wants to go fast. He still uses his wheelchair daily for strengthening but he's able to walk more on his own a little bit more each day. With the weather getting nicer, we've been taking him for walks around our neighborhood but still in his stroller.
He's been so happy going around the yard and inside the home on his wheelchair. He is also happy to be able to follow us around again, ring his potty bell, laying in a sunny spot and go after rolling tennis balls. We still put him in his pen or crate when he is alone and of course, no stairs. Our next PT session is this coming Thursday and the plan was to have him do the water treadmill.
We are very thankful for all your support. We couldn't have survived this without the help of this group. We know Lenny will continue to get better and even if he doesn't get back to 100%, he is truly happy.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on May 15, 2022 20:23:55 GMT -7
Aimee, just love your report. 4 months after his disc episode with paralyzed legs, Lenny followed classic textbook order and is now walking!! Wahoo!
You played an instrumental role with attention to strict rest for the disc to heal and not cause any more neuro diminishment. Good job, Aimee for that and graduation PT to keep his legs in condition while awaiting more nerve repair.
I am so very pleased to hear how Lenny is enjoying life!! Stop in again whenever you have news. It warms our hearts to hear from Dodgerslist family.
Would love to see him, if possible, with a video on the water treadmill.
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