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Post by Sarah & Ham on Jun 20, 2022 16:16:28 GMT -7
☀︎1-- Ham (short for Hamilton) is a 6 y/o French Bulldog. My name is Sarah.
☀︎2-- Ham is big for his breed at a very muscular 30lbs. Vet has never suggested he is overweight.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
30 lbs 6 y.o.
at U of PA post-op for laminectomy at L3-L5 ]
☀︎3-- Ham has seen several specialists. He is at the University of Pennsylvania Veterinary School hospital in Philadelphia. I get updates from the surgeon and neurologist each day. Starting tomorrow I will also hear from residents. I don't know anyone's names or credentials, but I have the highest confidence in them.
☀︎4-- Date of the surgery was June 18 - two days ago from this initial post. Therefore, I don't have answers yet for any of the rest of the questions, though I can update later. Instead I will share how we got here and the questions I have so far:
On evening of June 16, Ham did not get up to greet me at the door, seemed reluctant to walk, but was able to walk. I was aware of the possibility of IVDD in Frenchies and the conservative treatment protocol so I carried him upstairs and put him to bed in his crate for the night.
In the morning, (June 17) again seemed reluctant to come out of crate but eventually did. I carried him outside to yard. He walked a few steps to pee but then did not want to seem to move. I texted our vet (who was unfortunately on standby for our very elderly Boxer) who advised giving him 200mg of the Boxer's gabapentin and reporting back in two hours. Two hours later, he was still reluctant to move and had lost some coordination in back legs. Vet advised going to emergency vet. Went to two emergency vets, each of which had multi-hour waits. Finally someone advised me to just take him downtown to the emergency room at PennVet because if it was a disc issue as suspected, on a Friday afternoon, it was our best chance at getting an MRI and prompt treatment. By late afternoon when he was admitted at Penn, his back legs were not supporting him, but they did have some movement (Stage 3).
Because of the rapid progression, he was monitored overnight for testing and neurological assessment over time. They were prepared to do emergency surgery if necessary, but preferred to monitor, gather information, and complete the surgery in the morning. I don't know whether this was related to personnel or some scientifically based reason, but that was the plan. On the morning of June 18, they did an MRI followed by the laminectomy at L3-L5. The surgeon described a significant amount of disc debris spread throughout the field that needed a lot of cleaning up. He also expressed some concern that the spinal cord appeared "gray and unhappy". The surgeon said he expects patients to come out of surgery having taken a step back which indeed Ham had done, though he was concerned that he not only had no leg movement, but also no deep pain (Stage 5).
The day following surgery, June 19, Ham was kept in ICU because there was no change in his neurological status. That combined with the gray appearance of his spinal cord during surgery had the surgeon concerned about myelomalacia so they wanted to watch for worsening neuro status.
June 20, (today) is the second day post surgery and the news not great in that his neuro status has not changed, but that is good in that it does not suggest myelomalacia. So his catheter was removed and he was moved from the ICU to the regular ward for further monitoring. They said they feel they have found the right cocktail of pain and anti anxiety meds to keep him calm, but they are guessing he would be happier at home with me so the goal is to get him home in the next few days. We have had no further discussion of home care yet though I have certainly done my own research and feel I know what to expect. I can update the remaining questions when I get my official marching orders.
Questions:
1) Has anyone else had their pet go from Stage 3 pre-surgery to Stage 5 post-surgery? If so, please share your experience.
2) Has anyone else had their surgeon characterize their pet's spinal cord as "gray" or "unhappy"? What do you think this means in terms of prognosis?
3) I am currently in Philadelphia with access to one of the best vet schools in the country. However, my family typically spends the summer in Northern Michigan. In fact, the rest of the family left yesterday for the summer because our college aged kids started their summer jobs today. Just a few days later and Ham would have been in a small town where the local vet is overwhelmed with summer people and would not have been equipped to treat him, so he is a lucky unlucky dog. How long post surgery would you stick around Philadelphia before putting the crate in the car and joining the rest of the family? We do have a vet who is available to us via text/video but the nearest specialists would be 5 hours away and we would be 14 hours away from PennVet.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jun 20, 2022 22:01:20 GMT -7
Sarah, welcome to the Forum! Very happy to hear Ham is off the Myelomalacia watch list! When you have a specialist, do make it a point to learn all you can. If there is a phrase, treatment, etc you don't understand ask so you can learn...."spinal cord as "gray" or "unhappy" Even a resident could answer or get the answer for you. One thing no one can tell you is the date neuro functions repair on. This is the classic textbook order that nerve functions return in (the reverse order of the damage to the spinal cord): 1. 6/20 none 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 stump wagging with joy at seeing you or getting a treat or meal. 3. __ Bladder control verified with the "sniff and pee" test. 4. __ Weak leg movement, 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 without knuckling under.6. Ability to walk unassisted and perhaps even run. LEARN MORE: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/Knuckling: thumb.ibb.co/k3dqRS/Knuckling.jpgThere often is a degree of temporary setback after the surgery. Deep pain sensation can have the potential to self repair. It can take about 2 weeks before the surgery swelling resolves and you and the vet have a better idea of the path of healing. I bet your mind is flooded right now with many areas of concern, questions. 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/See if there are any other things you can do to make post-op crate rest go smoother with these very useful tips and ideas: dodgerslist.com/2020/05/14/strict-rest-recovery-process/My dog had a surgery 7 hrs drive away. When he was discharged, my local vet then looked after him, gave me extra lessons on expressing, took out the staples. So if you are going to Michigan, the local vet there would do the same. Having also a vet you can text/video with is a plus. Please keep us updated how your boy is doing. You may like to bookmark Ham's thread to receive an email alert when a reply has been made. Bookmark a thread to receive an email alert when someone has replied Go to the SURGERY Board dodgerslist.boards.net/board/7/surgery1. Look for Ham's thread and checkmark it. 2. Look for the white ACTIONS button towards top. 3. Select “Notification Options" from the pull down menu — check mark “NEW POST” change from never to INSTANT email — press the SAVE button. Click the “x” to close the window 4. Next choose the “Bookmark” See the tiny book symbol now! **  |
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Post by Sarah & Ham on Jun 21, 2022 7:55:32 GMT -7
WARNING: Terrible News & Euthanasia discussion - advice needed
The surgeon called this morning (6/21) to say that there had been no neurological improvement and they had measured 2cm of progression on the right side.
For this reason, combined with his observations during surgery, he believes that Ham does have either ascending myomalacia or at minimum focal myomalacia which would mean he would never (or qualified to highly, highly unlikely to) regain function of his hind limbs, would be permanently fecal and urinary incontinent, and leave him at risk of a sudden escalating episode leading to a painful and stressful death.
The team did not have any further diagnostic options to give a better crystal ball view of his prognosis. They did not feel another MRI would give them any additional information and would subject him to another episode of anesthesia. He essentially said I have three choices:
1) Continue to monitor him in hospital and watch for signs of ascending progression which would be a clear signal to euthanize him.
2) Let him go today based on the information I was given.
3) Hope for focal myomalacia only and, if stable for another day or two, plan to bring him home and care for him at home as long as possible, knowing that recovery is unlikely and risk is high.
I trust the surgeon and Ham is at one of the top veterinary hospitals in the country so I am reluctant to go off on any wild flights of hope. But, um, is there anything I am missing?
We have had pets go suddenly and unexpectedly before - a shar-pei with kidney failure, a boxer with a heart attack. I feel in my heart that pets should have a wonderful happy life, even if it is short. I never intended to keep him with us "no matter what". I just didn't know this could happen so fast. I didn't know when I handed over his strong little body to the best vets in the country that they wouldn't be able to fix him.
I need to decide what to do next and I need to decide what to tell my college-aged kids who are away from home and will be devastated. We also have a very elderly tumor-ridden boxer whom we expect to lose any time so we have been preparing ourselves for that. We never dreamed we would lose both dogs at once.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jun 21, 2022 10:15:19 GMT -7
If it were my dog, I would choose hope that it is focal "M". A dog can live a very happy life with a wheelchair. Learning to express the bladder will just give you a new normal routine which is totally doable. Being able to quickly asses signs of "M" advancing upwards is key to getting to a vet VERY quickly to save Ham from experiencing unnecessary pain for a fatal ending. It is important that owners are familiar with symptoms in order to promptly get their vet's help at any hour of the night or day. With ADVANCING Myelomalacia, what happens basically is that the spinal cord starts to die from the point of the spinal cord trauma moving forward toward the head. It can happen fast, within hours. It is a very painful ending.. making a dog unable to breathe. A local vet in another state (even your local regular DVM vet) may have never seen a case of Myelomalacia so you might want to print out the information and take it to the appt with you so you can discuss the signs you may be seeing--- whether it may be a possibility advancing. You may prefer to hang around where you KNOW you can get to your PA specialist or another vet on staff who is familiar with ascending "M" Should a dog be developing ADVANCING myelomalacia, before difficulty in breathing as the lungs shut down, you would want to help to cross to the rainbow bridge to spare a very painful death. Deep pain sensation or leg function not returning right away alone are not a symptoms of myelomalacia. The cause of M or how it progresses is still unknown. Myelomalacia can be easily confirmed by your DVM with the following. Also have your specialist on discharge go over each sign to further explain and answer your questions so you are prepared at home. * about 3-4 days into recovery, they become painful. Within the first week, they are in a LOT of pain. * acute disc extrusion with no deep pain sensation * development of excruciating pain (more than just pain from the original disc herniation) • hyper-esthesia (over-reaction to any touch sensation on body) • even the strongest pain meds do not help * loss of anal tone, the anus hangs open, (anal flaccidity) and areflexia (below normal or no reflexes) * neurologic deficits that localize to more than one neuroanatomical section of spinal cord (e.g. T3-L3 myelopathy and an L4-S3 myelopathy) * loss of cutaneous trunci reflex at a level more cranial to a previous evaluation over a period of hours to days with or w/o surgery * development of fever (normal rectal temperature is 100.5 to 102.5 degrees Fahrenheit) * sudden twitching or jerking of the neck and/or head * loss of voice, horse bark * Front legs can't hold body up, can't hold head up * increased respiration/ labored breathing (short, open-mouthed, belly breaths (not chest breathing) as the nerves to the lungs begin to shutdown More information: dodgerslist.com/2020/05/08/myelomalacia/I'm hoping and praying that this is not ascending "M" but would be a focal "M" that allows Ham to return to a happy life with his family who loves him dearly. Life is a journey. No matter where you are in the travels, live in the now. Dogs know to take life a moment at a time and enjoy it for all it has to offer. They move forward in life in the best way they can. Please keep us posted. Know that my heart is with your heart in thinking back when one of mine had ascending "M" |
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Post by Sarah & Ham on Jun 24, 2022 14:02:43 GMT -7
Hi, thank you for your swift response as I was needing to make decisions. I just wanted to come back and regretfully report that the deterioration did appear to be ascending. I considered waiting one more day and I considered bringing him home to spend some time and let our vet who comes to our home put him to rest, but the Penn vet seemed to discourage it. He said his pain was increasing and he suggested that the amount of pain meds needed to make him comfortable for the journey home would render him oblivious to my comfort measures. So I took the big fluffy blanket from my bed to the hospital along with some favorite treats. As soon as I saw him, I could see that the doctor was right. He was stressed and not himself. He did not want the treats and would not have been able to appreciate the trip home. But I was able to make him feel calm and loved, wrapped in his favorite blanket for a good long while before saying a peaceful goodbye. It was so sad. I never anticipated this and it all happened so quickly. Cherish the good times. Thank you for the work you do here.
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Post by Romy & Frankie on Jun 24, 2022 14:11:54 GMT -7
Ascending myelomalacia is a horrible disease with no cure or treatment. By helping Ham cross over the rainbow bridge peacefully while wrapped in his favorite blanket, you spared him from a lot of pain.
I am very sorry for your loss. My deepest sympathy.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jun 24, 2022 14:51:08 GMT -7
Oh dear Sarah and family! I am so sorry it turned out to be ascending "M". You gave the most difficult but kindest of gifts to let Ham go. Find comfort that you did everything you could to care for him. Ham knew that and could feel your love and calming smells of home in that blanket. Warmest of ((hugs)) and my sincere condolences.
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Post by Julie & Perry on Jun 24, 2022 16:24:10 GMT -7
Sarah, I wish I could give a hug to you. Losing a beloved pet is like an amputation. You abruptly have to part with an integral part of yourself.
Ham knew how much you loved him. Your actions surrounded him with peace and comfort.
Someday when your grief isn't so sharp you may choose ways to remember your beloved Ham.
I've remembered a loved and lost 💔 pet by sponsoring dogs in a rescue as a secret Santa, making donations in my baby girl's name for senior dogs, and giving her blankets to a senior dog in need.
God bless you and your family.
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Post by Sarah & Ham on Jun 27, 2022 19:41:44 GMT -7
Thank you so much to all of you who took the time to respond so thoughtfully. I currently have a very elderly tumor-ridden Boxer who is enjoying his last summer but could go any day. We never expected to lose both dogs at once. Previously, we had a Shar-Pei go with sudden kidney failure and Boxer who dropped with a heart attack. So this is our third sudden loss between 5-7 years of age.
All losses are truly awful, especially in the moment, but I know from previous experience that as time passes I will recognize that it is sad to lose a friend, no matter when, but the length of life does not matter so much as quality. I would be hard-pressed to say that a long, lingering life and death is better or worse than an action-packed life chock full of love. Other than the few days surrounding the surgery, Ham was non-stop fun, trouble, and cuddles. He was adored by his family and his big Boxer brother. He never missed a toy, trick, or treat. He gave him his best chance at recovery and a long life, but it was not to be. I know that when I get past the acute sadness, I will have no regrets.
I left the big fluffy blanket at the hospital - they said they would wash it and use it to comfort other pets. We have a second one that is still at the end of my bed where I will remember Ham's favorite spot. When his ashes are returned, we will bury them under a third lilac bush in a row along the fence line where the Shar-Pei and Boxer eternally guard the yard, greeting us each spring with fragrant blossoms.
Thank you again to those of you who are available on this board for fast information, encouragement, and support when it is so urgently needed. You are angels.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Jun 27, 2022 20:22:46 GMT -7
Sarah, thank you for sharing such a lovely tribute to Ham and your thoughts about the all too short life each spend with us. I love your idea of the fragrant spring greeting remembrance for each. If and when you might find it suits you, consider the idea of an educational legacy for Ham. Ask Linda to send you a free packet for your vet and wallet sized cards to hand out wherever you see owners of IVDD prone breeds. (Dachshunds, Beagles, Poodles, Spaniels, Shih Tzus, Pekingese, and Chihuahuas, Frenchies) dodgerslist.com/free-literature-2 |
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