Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Oct 15, 2022 17:12:14 GMT -7
[Mila - onset 10/05 - conservative treatment]
Hi, my name is Jaime and my dog, Mila, is a 14 year old (15 in a couple weeks!) rat terrier who is 8.44 lb. While on our morning walk on 10/05 at 8AM, she started screaming seemingly out of nowhere. I thought she had broken a bone or was stung by a bee or something, so I picked her up and took her home. When we got home, I couldn't see any stings or abrasions on her leg, but noticed her right hind leg was sort of just dangling whenever she attempted to walk. I called the vet and explained her symptoms, but they couldn't see me until 4:30PM. I asked if I should take her elsewhere and they advised to just keep her off her feet.
My vet is still no-contact so I had to wait outside during her exam. I got a call from the vet about 15 min after dropping Mila off and she said Mila likely had a herniated disc as a result of "back disease." She basically said my only option was surgery, within the next 48 hours, if I wanted Mila to have any sort of quality of life.
The vet prescribed Gabapentin and Trazodone (specific dosing info below) and gave me some neurologists to call. Everything was booked several days out, but I was able to speak to one on the phone to at least get more information. I got a basic estimate for the MRI + surgery + hospital stay, which was well over $11,000. They also explained conservative treatment as an alternative to surgery. Unfortunately, surgery isn't an option for me so I opted for conservative treatment.
I called my vet on 10/6 to let her know my decision and get whatever additional meds Mila would need. I didn't hear from my vet until 10/9 and she said she would prescribe Tramadol and Prednisone. Because I had been sitting around panicking for the past three days, I had done a lot of my own research on IVDD at this point and read that Prednisone may not be the best option for Mila because she just had a bad bout of pancreatitis on August 25, and other mild, ongoing GI symptoms (occasional vomiting episodes if I don't feed her multiple small meals throughout the day). I expressed these concerns and asked if an NSAID would be better and/or should she take some sort of GI protectant along with the anti-inflammatory.
The doc said there's always a risk of GI issues with Prednisone, but it was necessary for Mila's condition and that there isn't anything to prevent the GI issues. That, combined with the incomplete info she provided on 10/5 and the lack of urgency to get Mila on meds, made me start to question her treatment plan so I wanted a second opinion. I did start the Tramadol (not until 10/10 because she called after their office had closed) because I could tell Mila was still in pain, but held off on the Prednisone. I took her to a different vet on 10/12 who suggested Meloxicam instead of Prednisone due to Mila's history of pancreatitis. She also suggested getting x-rays just to rule out other things like cancer, etc. so I brought her back on 10/14 to do that and some blood work because my other vet didn't do either. She didn't see any tumors or anything else to explain Mila's symptoms, but she sent it off for a radiology consult just in case and I should hear back about that and her blood work on 10/17.
I've had Mila on strict crate rest since 10/5 and have only taken her out for the three vet visits and potty breaks. I've started trying to get her to go on a pee pad in my bathroom instead of taking her outside because I'm her only caretaker, I live in a high rise apartment in a very busy urban area, and she's leash-reactive to other dogs. Going outside was an incredibly stressful rigmarole each time because I was scared of her to re-injuring herself if something catches her attention. It would be different if I had another person to help monitor the situation, but it's just me 90% of the time. The downside to using the pee pads is that I'm probably picking her up more than usual since she's still figuring it out and sometimes refuses to go on the pads. I'm not sure what the best approach is or how to properly weigh the pros and cons for each option.
This site has been so helpful in understanding what's happening with Mila and what "strict crate rest" actually means. I also bought The IVDD Handbook by Dr. Marianne Dorn and I've been reading anything I can find online. The IVDD_SupportGroup subreddit has been helpful as well. It seems like you really need to advocate on behalf of your dog when it comes to IVDD because many general practice vets don't have as much experience in it, so I just want to be sure that we're on the right track and there isn't anything more I should be doing/asking my vet about.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
8.44 lb 15 y.o.
Meloxicam 1.5mg/mL as of 10/12: 8lb dose for 14 days, Sat 10/22 test STOP for _pain/_neuro
gabapentin 250mg/5mL: 50mgs (1mL dose) 3x/day
traMADol 25mgs 3x/day
Pepcid AC 5mg 1x/day]
☆ 1 • Gabapentin 250mg/5ml solution per ml): 1ml every 8 hours. Started 10/5.
• Trazodone 50mg tablet: 0.5 tablet every 24 hours. Started 10/5 and stopped 10/12 because Mila's new vet didn't think it was necessary unless she started showing anxiety even after her pain was under control.
• Tramadol HCL 50mg tablet: 0.5 tablet every 8 hours. Started 10/9.
• Meloxicam 1.5mg/ml per ml Oral Suspension: 8 lb dose (the syringe is measured in pounds for some reason, but I confirmed that it's correct) every 24 hours. Started 10/12. Stop date: 10/26 (14 day course).
• Pepcid AC 10 mg tablet: 0.5 tablet every 24 hours, given 1 hour before Meloxicam.
☆ 2
Mila 8.44 lb and is a female, spayed rat terrier. We live in the US. This is her first IVDD incident. My general practice vet said Mila still has deep pain sensation in her affected leg, but this hasn't been confirmed by a specialist.
☆ 3
Mila was presumptively diagnosed with IVDD based on an exam, her symptoms, and the absence of other indicators on x-rays. She has not had an MRI. My vet is a general practice DVM.
☆ 4
I took Mila to the vet on the date of onset (10/5) and she has been on strict crate rest ever since. She was seen by another vet on 10/12 and again on 10/14 for x-rays and bloodwork. From what I can tell, her pain has been successfully managed since 10/12. She has always been a high-strung dog, so it's a little hard for me to tell if she's doing something due to pain vs anxiety. Examples: she would always pant whenever it was close to feeding time or if she needed to go potty, and she would always tremble if something was making her nervous. That being said, she doesn't seem to have any trouble getting comfortable or sleeping, her appetite is normal, and other than the fact that her right hind leg doesn't work, she doesn't struggle to switch positions.
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Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Oct 15, 2022 17:40:05 GMT -7
[duplicate med list information]
Gabapentin 250mg/5ml solution per ml: 1ml 3x/day. Started 10/5.
• Tramadol HCL 50mg tablet: 0.5 tablet (25mg) 3x/day. Started 10/9.
• Meloxicam 1.5mg/ml per ml Oral Suspension: 8 lb dose (the syringe is measured in pounds for some reason, but I confirmed that it's correct) 1x/day. Started 10/12. Stop date: 10/26 (14 day course).
• Pepcid AC 10 mg tablet: 0.5 tablet (5mg) 1x/day, given 1 hour before Meloxicam. Started 10/15.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 15, 2022 18:01:19 GMT -7
Jaime, welcome! Kudos to you for reading and learning all you can. Not all vets know IVDD. But you certainly can know one disease. Good news from you pain is in control with two pain meds (gabapentin and traMADol) which have been Rx'd at an aggressive approach of every 8 hrs. Good news to hear stomach protector Pepcid AC (famotidine) is on board. For an 8.44 pound dog should be dosed every 12 hours as that is how long it is most effective at. 0.44mgs famotidine X 8.44lbs = 3.71 mgs famotidine every 12 hrs. Verify if you can simply round up to a 5mg dose every 12 hrs. Your dog has to have deep pain sensation because she can pee on her own so no need to seek a neuro specialist to tell you that. This bodes well for that one right hind leg to at some point in time be able to self heal those nerves! HOW TO MONITOR FOR NEURO DIMINISHMENT As damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if excessive back/neck movement for example. Tell us more about the right hind leg. Does she attempt to use the right hind leg to reposition in her suite? attempt to scratch an ear?1. 10/5 Pain with initial tear of disc and ensuing swelling 2. ___Wobbly walking ___ legs cross 3. ___ Nails/toes scuffing floor 4. ___ Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all 5. 10/5 Weak/little right hind leg movement, ___ can't move up into a stand 6. ___ Legs do not work at all (paralysis, dog is down) 7. ___ Bladder control is lost. __ Leaks on you when lifted. ___Can no longer sniff and then pee on that old urine spot outdoors. 8. ___ Tail wagging with joy is lost 9. ___ Deep pain sensation (DPS), the last neuro function to be lost, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. GI TRACT SYMPTOMs For most dogs Pepcid AC alone 2x/day will do a very good job of suppressing acids caused by Meloxicam, nerve damage and changes in routine stress. If Mila shows any indication of GI damage (not eating well, loose stool, vomit moving to bleeding ulcers, red or back blood in diarrhea) immediately phone your vet to report and advocate for both Pepcid AC & SUCRALFATE. Sucralfate works in a different way to gel coat any stomach lining damage AND to provide a protective environment for healing. LEARN MORE: Sucralfate
POTTY TIME We do recommend a pee pad adjacent to the recovery suite! Save a bit of old urine on a paper towel in a ziplock baggie. At potty time, place a piece of the urine stained towel on the pee pad. Set her down and command "go potty" When you see her sniff or circle, command go potty again. When she does praise her. Soon she will come to understand it is ok to pee on the pee pad. LIFT and CARRY (support both ends, keep back horizontal to the ground) Fewest of footsteps for Mila and your supporting both ends when you carry her should do a good job in making sure there is not too much movement of the back during potty breaks.  dodgerslist.com/2020/05/20/back-support/ |
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 15, 2022 18:19:40 GMT -7
Let us know you are on the same page about the importance of following STRICT Rest. The hallmark component of conservative treatment is the very STRICT crate rest part ( no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong disc scar tissue to form. STRICT rest means: ◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you ◼︎no chiro therapy WHYs: dodgerslist.com/2020/04/22/chiropractic/ ◼︎no dragging or meandering at potty times. Use a rear sling (long winter scarf, belt, length of ACE bandage) to keep her back from twisting and tipping over.  ◼︎no PT for conservative dogs during 8 weeks to heal disc ◼︎At-home laser or acupuncture for severe neuro damage avoids risky to the disc car transports. Transports are always a risk to the disc of too much movement. Vet visits must be weighed risk vs. benefit for dogs with only one leg affected. I know it is upsetting, but Mila really does have a good chance to heal those nerves. Think in terms of months rather than days/weeks for the slowest part of the body to heal— nerves. ▶︎ Roadmap for your fridge. Stay the course, avoid dangerous detours for the healing disc. D/L and print out: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf |
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Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Oct 15, 2022 18:34:56 GMT -7
Thanks so much for the speedy response!
I just texted my vet to ask about upping the frequency of Pepcid 5mg from 1x to 2x daily. And I'm so happy to hear that you recommend the pee pad! I will try the your suggestion of placing something with her urine on it. I hope she gets the hang of it soon. That alone will make this entire process so much easier on the both of us.
Here's some more info about her right hind leg:
• She does attempt to use it when repositioning.
• I haven't seen her use it to scratch her ear, but I haven't seen her use her other leg to scratch either.
• She can still get up to a standing position on her own.
seem to have any trouble standing up using the other three legs.
• When I place her down to go potty, sometimes her paw knuckles under and she doesn't try to correct it.
• When I wipe her down with dog wipes she moves the leg a little when I get to it. Not as much as she moves her other legs though, so I don't know if that's just a reflex.
Thanks for the video about properly lifting and carrying her. I read about this after she yelped when trying to pick her up after going as potty on 10/6 and felt so bad. I was surprised because the tech who brought her out from her first appointment was letting her bottom side hang and handed her to me that way. Should I explicitly tell people how to hold her if I need to take her during the recovery period? I've never had to tell veterinary staff what to do so this whole experience has been weird for me.
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Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Oct 15, 2022 19:14:12 GMT -7
We are 100% on the same page on the importance of strict cage rest. I've gotten nearly all of my information regarding crate rest from this site and I'm following all of the recommendations. I bought a pen instead of putting her in her crate because I wanted to attach a water bowl to the side without it blocking her ability to turn around, but I have it folded(?) so that she still only has enough room to stand, stretch out, and turn around.
Mila doesn't have any more vet visits scheduled so hopefully we're done with the transports for awhile. Luckily, both her old and current vet are within a 5 minute walk from my place so I haven't had to transport her in a car. I know there's still a lot of movement with me carrying her and walking to the appointment though, so Mila's new vet said she's cool with doing as much over the phone as possible.
It's great to hear that Mila has a chance of healing some of the nerve damage! My vet expressed the same sentiment. That would be amazing and I hope it happens, but as long as she can heal enough to not be in pain and live a life outside of this pen, I'll be ecstatic!
I've been reading about laser therapy and the vet said that they even sell at-home lasers for people to use on their pets. Do you have any recommendations on which brands to look at? They're kinda pricey so I really don't want to get scammed haha. If I do end up getting one, should I hold off on using it until after 8 weeks, or is that something that can be done during recovery?
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Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Oct 15, 2022 19:20:10 GMT -7
Oh, sorry, I responded before reading the roadmap and now see that I don't have to wait to start laser therapy if I can get the treatment done at home. Thank you!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 15, 2022 19:21:33 GMT -7
Jaime, this is good neuro news that Mila can still use that right hind leg to reposition!!! With your excellent attention to the single most important part of conservative treatment, I think you will see some nerve healing going on. Remember the whole focus right now is not to disrupt the early healing disc scar tissue by employing limited movement of the back. Nerve healing might or might not be able to some back in the short time of 8 weeks it takes for disc healing. Vets are amazing people. Did you know that during the course of their day they might be a dentist, a pediatrician, a surgeon, a dermatologist, etc. ? The unlike your own doctor who only treats one species (the human species and refers out to a surgeon, a dermatologist, etc), your vet treats many species: cats, dogs, reptiles, birds, farm animals. Is it a wonder that they may not know every disease in detail. They know a lot about body systems, anatomy and with some quick research may be a quicker study on a new-to-them disease than you. But there is no doubt you CAN become quite educated to the point where you can bring ideas up for discussion and do a very good job in advocating for what Mila needs. Anyway this is what a lot of us have found out — we need to be IVDD savvy pet parents. 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 the vet we've hired to be on the IVDD Health care team.
Be polite but firm on how to properly carry your IVDD dog, teach in a positive way how the disc needs to be protected. Does the new vet allow you to always accompany your dog (weighing, on the exam table, etc.)? Who knows which vet techs are not IVDD savvy, who knows who will be touching your dog when you are not there to observe things. Put an IVDD tag on the harness where it is prominent, so you can bring up in conversation how you carry your dog. dodgerslist.com/2020/05/20/back-support/Our hope is you will continue to delve into the readings on our Main Webpage www.dodgerslist.com and be the prepared IVDD savvy owner your Mila needs her advocate to be. 1) Shortcut thru IVDD (10 mins overview): dodgerslist.com/2020/06/26/time-and-ivdd/ 2) This is a good spot to start: dodgerslist.com/in-the-right-place/ 3) Do click on the rest of the "KNOWLEDGE" pull down menu items.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Oct 15, 2022 19:28:55 GMT -7
Jaime, your new vet would be in the best position to recommend an at-home laser for Mila. Or maybe you have a mobile vet who will come to your house? Ex-pens are really versitle and handy for now and even after graduation day (we'll have lots to share with you then). You could expand the panels for potty time and put down the pee pad there. This way Mila can't attempt to dart off.
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Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Oct 15, 2022 19:57:14 GMT -7
Thanks so much for all the information! I will see if my vet can recommend a specific laser because it'd be great if I could just do it myself because I think having a mobile vet come by to do it would stress Mila out.
Oh and I definitely agree that vets are amazing people! I still think that even about Mila's old vet. That quote along with the resource you provided about advocacy are great. I've been encouraging my mom to advocate for herself more with her primary care doctor, so I don't know why I felt weird doing that for Mila. And I love the idea of adding an IVDD tag to her harness! I am able to accompany Mila throughout her entire visit at the new vet, but I think having the IVDD tag will make it easier for me to bring it up without feeling weird.
I will continue reading everything I can on this site and won't be afraid to ask my vet questions or bring up things I've learned. Thanks again for answering all my questions and providing such great resources.
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Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Nov 9, 2022 13:38:50 GMT -7
I thought I would provide an update. Mila has been off all of her meds for about a week now and is doing well. She is quickly regaining function in her leg, which is amazing, but has also made crate rest more challenging because she wants to get up and walk around. I've been sticking to it and plan to go another 4 weeks to ensure proper healing. She's finally gotten used to going potty on a pad on the bathroom, which has made life a lot easier. I bought a few packs of reusable pads and a diaper bin, so it's not as disgusting as it once was and is less wasteful.
I've been trying to keep her stimulated and content in her crate using lick mats, but she wasn't that interested. My mom made a few cute snuffle mats (one is taco and one is dim sum themed!) and she loves those! I use them to feed her and Mila seems mentally exhausted after and can actually settle down. Any other tips on how to make these final weeks of crate rest more tolerable would be greatly appreciated!
All in all, things are going really well! The first few weeks were absolute hades, but we've finally got a routine down and i see little bits of progress every day. I've been keeping a journal of progress, setbacks, frustrations, etc. and that has really helped center me on days that are especially frustrating because it's hard to recognize how much better things have gotten if I don't have something to reference. Anyway, that's all! Just thought I'd share for those who are still struggling.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Nov 9, 2022 17:37:25 GMT -7
Jaime, what a really wonderful report on so many levels. First is being off of all meds and no pain AND neuro function improving with the self healing of nerves. The disc, too, is healing and with your commitment to give that 8 weeks to self heal with some strong scar tissue, Mila will have an excellent graduation on Dec 7. Keep us updated, we'll have lots of tips and ideas to share with you on Dec 7. Your establishing a routine makes it easier for everyone. Dogs especially are creatures of a routine. Good job, Mom, coming up with those snuffle mats! Here are some other ideas to consider: MENTAL STIMULATION During recovery time, physical activity must be restricted. A dog can not be allowed expend energy in physical activity to become tired. For dogs mental stimulation can be just as tiring. You can help in that department. — Choose only the activities that can take place inside the recovery suite. Make sure the activity that do not exceed the demand for 100% STRICT rest for the back. Mila would be lying on the stomach or maybe quietly sitting. Use her daily food rations as the rewards. — Adapt each activity so that it takes place inside of the recovery suite while you sit on the floor in front of the suite's open door. Stop if your dog is getting over excited and displaying rambunctious behavior of too much neck/back movement. — Quietly lying down or sitting on the butt inside the recovery suite is the aim in avoiding too much movement for the back. — Try some training to give the brain a mental workout..brain work can be tiring but a good thing. —Keep training sessions short about 7-10 mins. — Keep the game going as long as your dog is truly engaged, not bored. — If your dog loses interest, end the session for the day. Always end on a positive note by giving a command you know your dog will perform such as eye contact, then treat and praise. #1 Teaching self-calming exercises can also help your dog to relax more. You can make something as simple as eye contact a very rewarding behavior that also acts as a way for your dog to “ask permission” when she wants something. When dogs have a focus and an understanding about how to behave to get what they want, they are much calmer overall. To do this, each time your dog looks at you, say, something like, “Yes!” or use a clicker to mark the second she looks at you, and then give your dog a food reward. [NOTE: for crate resting dogs, shift your body a bit to change your angle] .... wait for your dog to look up at you again, say, “Yes,” and reward again. Do this exercise 10 or so times and then say, “All done,” and put the treats away. Come back later and do it again until you can see that your dog is really starting to make automatic eye contact in hopes you will say, “Yes,” again and give a reward. [NOTE: treats should be subtracted from the normal daily kibble ration so as not to gain weight during crate rest. Lo-cal treats are tiny pieces of apple or carrot. To dogs the size of the treat matters not. They work just as hard for a big piece as a tiny piece.] #2 lip lick:
As long as your dog does not have a neck disc and will calmly use a kong, it can provide your dog with a job during crate rest.... to work at eating dinner via a kibble meal frozen into a Kong. Licking and eating will now more time & effort and it is stimulating. Be sure to subtract what's in the kong from the daily kibble allottment so as not to gain weight. what/how to stuff and training tips:
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Jaime & Mila
New Member
FEMALE - Rat Terrier right hind leg affected
Posts: 8
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Post by Jaime & Mila on Nov 9, 2022 19:30:36 GMT -7
Yes, I had already prepared myself for a much worse outcome so this has been a pleasant surprise.
She has never been a food-motivated dog, so she didn't get into the kong or similar toys. She basically acts like they're more trouble than their worth haha. I will try some training though because that might be a little more interesting to her. Thank you!
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