Assam's Sandini 5/2 surgery4wk - GRAD 5/31

Welcome! Please correct if the names are not right.. Your name is Assan and your dog is Sandini?

There is a window of time most surgeons believe the risk of a surgery is warranted.
Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance.
    Do know should the neuro believe the window of time for surgery to warrant the risk had passed, do NOT loose hope!
     Employing real, true conservative treatment of 8 weeks of strict rest for the disc to heal, there can be potential to heal nerves.

While you are prepping for discharge day and getting the recovery suite ready, do also bone up on disc disease. Your knowledge can be helpful in discussions with a vet and caring for Sandini.
▶︎ Super tried and true tips for setting up the recovery suite, the mattress and more! dodgerslist.com/2020/05/14/strict-rest-recovery-process
▶︎ Shortcut Thru IVDD: dodgerslist.com/2020/06/26/time-and-ivdd/
▶︎ I bet your mind is flooded right now with concerns, questions for when Sandi comes home. Now is the time to jot those things down. Here's a starter list of questions to which you can add some of your concerns to ask your surgeon: dodgerslist.com/2020/06/03/discharge-day-list/

This page is good reading by Dr. Isaacs, ACVIM (neurology) as he explains many post-op questions for our IVDD community: meds, crate rest, PT and discharge day. dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/

As you get updated by the neuro, when you have time, do let us know how Sandini is doing.

Assam, wow, usually a dog stays for a couple of days at hospital until proved oral meds will fully control pain.  
            So do observe Sandini for any signs of pain nearing his next dose of meds and when he attempts to move.  You are the eyes and ears for the surgeon to know if his Rx needs any adjusting.  Have no patience with pain, alert the surgeon to get the meds adjusted.  Observing a 2nd or more signs helps to confirm if whimpering is an attention-getting sound or likely a sound caused by pain.

If at the end of the week when the cathether is taken out, Sandini has not regained bladder control he will need to be expressed. You seem concerned about expressing. Expressing might sound scary. It certainly did to me. It is a skill and must be practiced and learned. But dogs of all sizes can be expressed. I learned to express my dog and if you need to express Sandini you can learn too.

Assam, good news on giving more space in the recovery suite so Sandini can now turn around.  A slow transition back to a raw diet is also helpful if it is full rounded in vitamins, minerals and good source of protein. Bone broth the way you are making it is excellent with  the high cartilage feet, neck bones!

PAIN EMERGENCY
Please let us know about the shivering (pain or chilled?) in the morning and if keeping room temperature a bit higher helps. Pain hinders the body in healing. Have no patience with pain. It appears Sandi is in pain.
        This morning report pain that could be helped with  pain med adjustment. 
--- Shivering happens after 8 hrs or more of sleeping by the morning.
--- Panting occurs before his next pain med (gabapentin 200mgs every 8 hrs).  
    Assam, it can take about 14 days before all the surgery caused painful inflammation subsides. Til then no way should Sandini be allowed to suffer with pain!  IF gabapentin alone is not providing round the clock freedom from pain, then discuss a typical pain med cocktail of gabapentin (nerve pain) +methocarbamol (muscle contraction pain) + traMADol (overall analgesic).

NEURO FUNCTION
Because Sandini does not yet have deep pain sensation, that means his back legs have lost connection with his brain, and he does not yet have bladder control and he does not have bowel control.


While no one will be able to put a date to when each of the neuro function might come back in, it is known what the order will be in.

TYPICAL NERVE HEALING ORDER:
1. __Deep Pain Sensation: 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.
3. __ Bladder and bowel control verified with the "sniff and pee" test.
4.__ Weak 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.
LEARN MORE: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/

POOP, HOW TO HELP
Tell us, was the poop rather firm/constipated?  The longer poop stays in the digestive tract the more moisture is removed.
    --- High fiber plain pureed canned pumpkin can help. Give a teaspoon of pumpkin for every 10 pounds of body weight
    NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato.
    --  To loosen the stool, add  extra liquid to his raw hydrated diet. At mealtime add 4 teaspoons of plain canned pureed pumpkin 1x a day.
    --  To firm up the stool add 4 teaspoon plain canned pureed pumpkin 1x a day to kibble.
    
Expressing poop is the same technique for a small dog as for a large dog.      Expressing for poop is so that 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. You can express while Sandini is lying down. Try expressing 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:
Catheters are a last resort thing. Any unsterile use can cause bladder infection. Expressing is something you can learn. Expressing is to prevent:
  -- Over stretching of a bladder wall with a full bladder.  This could ruin the tone of the bladder muscles. Then when the brain can again connect with the bladder nerves, the bladder won't be able to operate properly.
  -- Urine remaining in the bladder will very quickly in a matter of days become a raging urinary tract infection (UTI).
   -- Please prepare yourself with an idea  how to express the bladder. When the cath comes out, you will need to have the vet put his hands on top of your hands so you know the pressure required to make the neck of the bladder release urine.     Now is the time to educate yourself for Monday 3/9 appt:  BLADDER and BOWEL expressing: dodgerslist.com/2020/05/05/bladder-bowel-care/

You can massage his anal area when he is lying down. If poop needs to come it will come when he is in that position. You can hold him in a squat position if he is showing signs that he wants to poop. A few minutes should be plenty. Since he pooped earlier, he may not need to again today.

Assam, good to hear poop is moving thru his digestive tube in a more normal manner. Hopefully it was not so firm as to be constipated?

    Expressing for poop is not a health issue. As all poop will exit the body with reflexes until nerve connections repair.
    Expressing is then so that Sandini does not have anxiety of smelling/finding poop in his sleeping quarters.

    Expressing for poop is for you to initiate the reflexes to act earlier to push poop out when you are there to have it fall on a pee pad or whatever to catch it and prevent it landing on Sandini bedding. He will smell the poop on his bedding and won't like that at all.


        Watch the finger technique on the video I gave. It does not matter what position Sandnini is in. What matters is your finger technique.

    This method of expressing for poop is safe, simple, non-invasive. Let us know if you are able to express for poop about 30-60 mins before you expect mother nature might push the poop out to plop anywhere.

Assam, you are figuring out some good things about Sandini's care. Thanks for sharing those thoughts.

Range of motion CAN be done with the dog lying down OR it can be done from a standing position. It is important to do the range of motion (ROM) to keep the joints flexible. Posting the video again for you to look at:
        - 2:02 mins in demos ROM in a lying down position.
        - At the end a PT person demos how to do bicycles (ROM) from a stand position.

Either the cone does not permit him to lie on his side OR he is in pain still from the surgical procedure. It can take about 14 days for all that surgery caused pain to subside.

Not fair for Sandini to be painful when your surgeon or vet on duty can adjust meds over the phone.

Have no patience with pain. Pain hinders healing.

Assam, very to good have an up date on Sandini!  It is still early in the nerve healing department as nerves are quite slow to heal. Even so, excellent to hear that Sandinin HAS healed some nerve functions already:  has bladder control even if not yet perfect, can move up in to a stand by himself, moves his hind legs in a walking motion even if weak and legs cross sometimes.

POST-OP REST length?
The reason for post-op rest is to allow all the surgery areas to heal. Many surgeons direct 4wks and other depending on the case  may direct 6 weeks of rest.  How many weeks  does your neuro want for post-op rest? We'll have lots of great ideas and tips for reintroducing family life and physical activity once we learn Sandini's graduation date is.

BLADDER CONTROL
The leaking can be due to a couple of reasons.
---  Urinary tract infection (UTI) will cause urine leaks. When is the last time Sandini has  had a urinalysis to know there is no  bladder infection going on? If a bladder infection, then very important to get an antibiotic on board ASAP.  Let us know.

--- When bladder control is returning, the urination process may not yet be fully functional.  Any pressure that is similar to the pressure that expressing purposes causes  urine to be released can happen with the pressure of a belly sling  or the pressure of stomach muscle against the bladder as a dog makes effort to raise up into a stand position.

BELLY BANDS
Belly bands can cause their own problems or dampness/rashes same issues babies have to deal with diapers! Best if you don't need to use.

This tip and many other good ones comes 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 fur and skin.
    -- 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 linens and hard surfaces such as floors & recovery suite area.

BOWEL EXPRESSING
    When the bladder control comes back,  bowel control comes back usually around the same time.  
    Find out if Sandini can wait til he is outdoors and  poop on his own. Maybe his bowel control is back and you won't need to express for poop.  Let us know what you observe.
    
Bowel emptying is not the health issue that bladder emptying is. All poop will come out.  
    The ideas is IF you can figure out his normal time for poop to plop out, you can THEN express to have it exit in a better place than his bedding.  That place could be out in the yard.  It could be indoors on a pee pad OR over your toilet.
    Based on the schedule you observe poop comes out on its own, you would try to express about 30 mins ahead of time (outdoors or over the toilet).

WATER CONSUMPTION
Does Sandini drink water on his own like he did prior to the surgery?  
Does he always have access to water inside  his recovery suite?
Don't understand why your question of how much liquid to give him, please explain.

Sandini should have free access to water inside his crate. It is okay to remove it a few hours before bed to avoid accidents. To avoid a mess you can try something like the below:
dodgerslist.com/wp-content/uploads/2020/05/bowl-holder-DIY-320x240.jpg

Could you explain what "no feeling in hind leg yet" means. What do you observe the has you using this phrase?

Can he can push his butt up with hind legs to get in a stand position all by himself?

Assam, nice report on what the Neuro said. The first neuro function to return is deep pain sensation (DPS). Sandini is way past that in that his neuro function allows him to push up with hind legs into a stand and he can move the legs in a walking motion. Naturally, there would be no reason to do the the harsh DPS test, Sandini HAS deep pain sensation!

Soley standing is a good thing as it is weight bearing and good for bone health.  It is the ability to push up himself into a stand that is the neuro function we were interested in.  Some dogs can stand if put in the stand position merely by reflexes.

There is a typical order to healing nerves. However some dogs the order is not exactly textbook. They do gain control of leg function before bladder control is a perfected function.

TYPICAL NERVE HEALING ORDER:
1. _√_Deep Pain Sensation: 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.
3. _some_ Bladder and bowel control verified with the "sniff and pee" test.
4._√_ Weak leg movement, and then
    _√_ ability to move up into a stand position, and then
    _√_ wobbly walking.
5. __   Being able to walk with more steadiness
6. __  Ability to walk unassisted and perhaps even run.

As indicated by your neuro, graduation from post-op rest to heal the disc is something to slowly introduce. 

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 conditions of leash, harness and sling. Not free riegn of the house and yard immediately! LOL  Whenever you are not supervising eyeball to eyeball, Sandinin should be in his recovery suite.
      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.

SAMPLE SCHEDULE
See if there any additional ideas to what your neuro said in this 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%20schedule

PROTECTION from now on around the house
   
    **
 
1) Blocking off furniture ideas: dodgerslist.com/2020/07/09/home-protect-ivdd-backs/%E2%80%8B?highlight=FURNITURE%20BLOCKER
2) When Sandini's legs are stronger, train him to use ramps.

HAPPY DAYS AHEAD
1) You and your dog have survivied a disc herniation! Learn what you can do from this point forward. 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 senior dogs need to stay limber, severe arthritis might make certain movements inappropriate.
- Underwater treadmill therapy at the PT Clinic would be an excellent at this point in time for Sandini.  
    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.
- Water therapy at home:  dodgerslist.com/2020/05/28/surgery-dog-water-therapy
- Strengthenin core muscles.
    Core exercises don't require specialized equipment.
    Here are some exercises you can do at home:
    5 exercises: totofit.com/five-basic-exercises-essential-to-building-core-strength/

May we turn the tables and ask YOU for help?
      Did you know there are less than a handful who volunteer daily to help dogs and their owners? We need helping hands from other Forum members in educating.
      Education about disc disease is our number one mission!
We invite you to hop on to our educational bandwagon team. Too many dogs are put to sleep because owners lack education about IVDD treatment. STRICT crate rest and proper medication have helped many dogs recover. We depend on all members to pay it forward for the help they have received with their dog by helping us educate!

Pick what suits you....
We depend on you. Here are some ways to help..
              i.postimg.cc/R0y7zpGx/IVDD-survior-gallery.jpg **
-- Please celebrate Sandini's graduation! Add a graduation photo and a short caption to our Gallery to give other members inspiration about your IVDD Survivor! dodgerslist.boards.net/thread/2262/add-dog-dodgerslist-photo-gallery
-- "Share" our FB posts www.facebook.com/Dodgerslist
-- When in conversation at the grocery store line or wherever you may meet breeds most prone to IVDD (Dachshunds, Beagles, Poodles, Spaniels, Shih Tzus, Pekingese, and Chihuahuas, Frenchies) give out our free little wallet cards.
Hand carry our literature and print out our letter of introduction for your vet.
linkable [►ORDER BROCHURES & cards, they're free!◀︎] for your vet and wallet cards for you: dodgerslist.com/free-literature-2/
             
-- Would you consider helping another trying to make decisions about surgery?
We have a directory where you can share surgical info.
         
    State:
    Hospital:
    Address:
    Cost:
    Date of surgery:
    What was included in cost (MRI?, days stay, ER? PT? meds for home, sling, etc.)
    Comments:

Don't be a stranger! Stop in periodically. We really do love to hear how Sandini is doing. We'd love a short video clip to see Sandini in action at home, at PT and living & loving life in spite of IVDD!
    if you see a new member in a tough spot, give them hope. A brief paragraph about your dog can be insanely supportive and inspiring in a time of need!
                    

Let us know what therapy the PT person recommends for Sandini and how that visit went.

Assam, it warms our hearts to know we could help you out during troubling times.

Water therapy is an umbrella term.
    -Swimming is water therapy that practices swimming.
    -Underwater treadmill is a therapy that practices walking.

Sounds like Sandini is going to have an excellent opportunity to fine tune his walking with the underwater treadmill therapy!!!!

Take a picture if you are able, we'd love to see Sandini in action at PT!

Cavaletti poles for Sandini to step over would be a good form of PT. They can help with balance and muscle strengthening. There are different ways of setting them up, so you may have to experiment a bit to see what works best for Sandini.