Madeleine's Lucy 8/10 surgery4wks C.O. stones; GRAD 9/7

Welcome to Dodgerslist. 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.com/2020/05/14/strict-rest-recovery-process
- shivering-trembling
- yelping when picked up or moved
- tight tense tummy
-arched back, ears pinned back
- restless, can't find a comfortable position
- slow or reluctant to move in suite such as shift positions
- not their normal perky interested in life selves
dodgerslist.com/2020/05/05/bladder-bowel-care/
www.marvistavet.com/prazosin.pml

It is very scary when our dogs have IVDD surgery. It becomes less so when we learn all we can about the disease. We have a lot of useful information at our main website:
www. Dodgerslist.com
You can use the search bar at the top of the page to search for specific topics.

Expressing is a matter of physics. That means the pressure applied to the bladder has to be greater than the strength of the sphincter to push the urine out.  Sometimes you have to hold that pressure many seconds longer than you think before the sphincter is overcome. When the bladder is really full, you may not feel a shape, just a firm stomach which is the bladder. As the bladder empties, it will shrink. When empty, it goes flat. As the bladder empties and gets smaller, it will move around, so it will not always be in the same position in the body. You will need to feel for it. You'll probably find it's moved farther back into the hip area. While expressing, squeeze and then wait for 20-30 seconds and then try again. You may find the bladder has moved a bit. You will know you have gotten it right when you are getting a steady stream.

Hi, my name is Paula, what's yours?

Don't be hesitant to go to your own vet or the surgeon's hospital. Make sure it is the kind of expressing lesson where the vet or the vet tech puts their HANDS on YOUR HANDS. Many of us have found an extra lesson to be helpful.that. This is a new skill for you and takes some practice to feel the bladder in all its stages of emptying. And as it empties it can slip out of your fingers, moving back into the pelvic area.

Did the surgeon say if Lucy had deep pain sensation before the surgery? Did he shay if she had deep pain sensation after the surgery?

Madeleine, thank you for giving us a frame a reference about DPS for your sweet Lucy.

Nerves can heal. While you nor your local vet would likely be able to correctly identify deep pain sensation (DPS), the happy tail wag is something no one can get wrong.

Hearing from you that Lucy is eating well and and has positive demeanor is what one would want to see in a patient. A good, positive attitude is good for healing post-op. My post-op dog's case was one who never was able to heal things beyond the tissue areas involved in the surgery to be able to ambulate again. Just so you can have a  calming concept planted in your mind for the future, if need be, dogs live in the moment and live life to the fullest no matter how they get around.

A perfect summer day is when….. 
Nerves heal typically in the reverse order of the damage to the spinal cord. No one will be able to give you a time table as each dog is different, each case is different. The usual is it is better to think more in terms of months rather than days/weeks for this slowest department of the body to heal- nerves.

1. Deep Pain Sensation: the first neuro function to return. 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, getting a treat or meal, or hearing happy talk from you.
3. Bladder and bowel control verified with the "sniff and pee" test.
4. 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.
6. Ability to walk unassisted and perhaps even run.
LEARN MORE: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/

Please keep us posted on how your proficiency level of expressing is going which keeps her dry til the next expressing time.   Is she currently staying dry until the next session? How often are you currently expressing?  While perfecting this new skill to be able to find & feel the bladder, it will take expressing every 2-3 hours.  As she would stay dry, then move up to every 3-4 even every 6 hrs.   At some point she will stay dry for 8 hrs during the night.

Would love to know your at home PT details. Which of the PT ones in the video below do you do?

Madeleine, if the videos are about success stories of all kinds of healing from a disc episode, then here are more: dodgerslist.com/success-stories

EXPRESSING
   It is very likely that the span of time from before to after work of about 8+ hrs, could well mean the bladder is overflowing due to reflexes.

Reflexes vs brain directed
For us humans to be able to distinguish between reflex and brain directed, we have to see some sort of head level involvement with the tail, with a limb or with release of urine so we know the movement was done with purposeful thinking rather than reflexes.
--- Sniff (head level nose) on an old pee spot, then release of urine would be brain directed.
--- Hear (head level ear) you doing some happy talk and then tail wags is brain directed. Tail movement during potty time can often be a reflex
--- Itchy sensation at neck and then tries to scratch would be purposeful movement. Tickling paws, etc can cause reflex leg movements of pushing in or out. 

IF the dog can't give you a happy tail wag, then likely the dog does not have bladder function yet.  An overflowing bladder when filled to capacity triggers reflexes to release all some but not all urine to escape.   
        Do you have any provision for someone to express Lucy's bladder during the day, or maybe you two can stagger your workday start times, come home at lunch?   When I had to go on a trip, my vet taught my neighbor how to express my dog.  
    Continual overstitching of the bladder wall muscles can ruin the tone. Then when bladder function comes back the bladder may not work as well as it should.  Also the urine remaining in the overflowing bladder can develop into a urinary tract infection.
   When first learning to express, one expresses more often (say every  2-4 hrs) because because there is not yet the level of getting all the urine out and the bladder refills often. When the goal of good  expressing skills has been achieved the dog stays dry session to session. Each expressing session voids the bladder taking it 4-6 hrs to refill and even 8 hrs. At night the body produces less urine and takes longer to refill.

You are doing a good job in making sure she has a dry place in the recovery suite to move away from wet areas.  Do you have the suite set up with the mattress as described on this tip page to  make clean ups easy:   dodgerslist.com/2020/05/14/strict-rest-recovery-process/
    ... mattress sealed in garbage bag.  Pee pad on top. Finally topped with tucked in all round like a bottom sheet:  with 100% synthetic wicking fleece from fabric store or inexpensive  Walmart throws?  The synthetic (no cotton) fleece holds the peed pads in place as a dog scoots in the suite.  Water bowl attached to the side of the suite. Gives more room and no accidental spills.

Madeleine, do tell! You know how we love the detail.

What circumstances did you observe a happy tail wag? Was it due to you doing some happy talk to her. Or maybe showing her a yummy treat?

When taken outdoors, is the sling slacked so it does not pressure the tummy/bladder area? Does she sniff and then release urine.

Madeleine, you have definitely provided evidence of DPS and neuro signals ability to go down to the tail!!!!!

Bladder control.
--- Stays dry in her suite until you take her outdoors for a potty break. This one is tricky.  Because if she is not being taken out often enough, she has no choice but to pee where she sleeps 
--- Can sniff and then make the decision to release urine in that appropriate place.
--- At potty time release the tightness of the sling against her belly.  She'll still have the sling and it's handles in your grip but sling pressure will be relaxed.  In case of her body starting to tip over you can immediately provide sling support again.
--- When a dog's bladder control is beginning to come back, they will not likely want you expressing their bladder.  Still it is a good idea to let them pee what they can themselves with that sniff and pee.  After they are finished, do a quick express check until you are satisfied each time all the urine has been voided from the bladder.

We are interested in what your regular vet says at this morning's vet appt and then Thurs 8/25 with the neuro—  if these vets determine any neuro self repair is starting in the legs (can right the knuckled under paw, makes any attempt to try to raise up in a stand, etc.)

1. √ YES! Deep Pain Sensation: the first neuro function to return. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about this very tricky to correctly idenfiy neuro function.
2. √ YES! Tail wagging with joy at seeing you, getting a treat or meal, or hearing happy talk from you.
3. _?_  Bladder and bowel control verified with the "sniff and pee" test.
4. ___ Weak leg movements, 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 .

Madeleine, glad all those who saw Lucy were pleased with her progress and getting your confirmation from a professional that has, indeed, DPS!

Did the neuro say when her post-op rest would be over...still 4 weeks with graduation on Sep 7?  Or.....?  As soon as we know she's graduated we have lot's of information in slowly introducing her back to family life and activity in a safe manner.

Good thing the stones where caught and now she can be on an appropriate diet to manage. The stones could make expressing uncomfortable.  After bladder control starts to return, then the next neuro repair are the legs. With your rehab confirming she attempt to move up into stand on her own, have you got proof yet with sniff and pee that she can void her bladder on her own? If she can, then do a quick express check until you are satisfied she can empty the bladder each potty time on her own.

The surgeon directed post-op rest is typically for the amount of time to heal the surgical areas.

Have you had an opportunity to witness Lucy sniffing an old pee spot outdoors and then releasing urine?

Glad to hear of the new exercise of weight bearing legs. Important for bone health.

Questions:
1. What kind of PT can I be doing at home to strengthen her hind legs? Are there any videos?
2. At what point would her progress stop? My vet says that at 6 months, we have probably seen the majority of progress that she would make. Don't get me wrong, Lucy is HAPPY HAPPY and her personality has returned 100%. I am quite content if this level of care is indefinite, but I am just curious.