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Post by Chris & Gus on Feb 5, 2023 14:20:00 GMT -7
1) Gus, 6.5 year old French Bulldog - parents: Chris and Carrie
35lbs
2) Neurology Surgeon
3) Surgery 02/01/23 - Paralysis in hind limbs and deep pain negative
4) Yes, doing strict crate rest except for PT and attempt to express.
5) Vet provided instructions for PT include massage of hind limbs + toes, bicycle motion, and “stand, sit” simulation.
6) Six weeks strict crate rest broken down into 2 week increments of short activity (potty breaks and short walks).
7) Occasional shiver but subsided shortly after pain medications.
8) Carprofen - 75mg, half tablet every 12 hours
Gabapentin - 100mg, two tablets every 8 hours
Trazadone - 100 mg tablets, one every 8 hours
Diazepam - 5mg tablet, one every 8 hours
Phenoxybezamine - 5mg tablet, one every 12 hours.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
35lbs 6.5 y.o.
carprofen 37.5mgs 2x/day
gabapentin 200 mgs 3x/day
diazepam 5mg 3x/day
Trazadone 100mg 3x/day
Phenoxybezamine 5mgs 2x/day]
9) currently, Gus still maintains paralysis in his hind legs. He is still deep pain negative. We have our follow on appointment on March 9 with the neurologist to identify any progress.
10) additional: like many others, Gus was walking normally, and less than 24 hours later he was completely paralyzed. We are obviously devastated, but hoping for the best. He is currently on Day 4 of Post-Op, so we are still keeping our fingers crossed for no complications.
The one thing we are having issues with is his urination. The Vet/Neurologist informed us that his bladder was very difficult to express. However, he seems to urinate (likely involuntary) on his own [overflows] throughout the day and night in significant amounts. We are constantly attempting to keep him dry and change out his towels, and pee pads, but it has been overwhelming. We can’t see to get him on a consistent schedule and he leaks throughout the day. Could this be a side effect of the medication? Also, he is defacating pretty frequently, and his sphincter remains wide open, almsot leading to leaking of poop throughout the day. He pooped over night in his crate the last two nights, and was covered in it.
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 5, 2023 15:21:45 GMT -7
Welcome. Chris is it you who writes? Hi there, my name is Paula. We are glad youv'e joined us all here. How did you find us? If Gus' pain starts to surface before the next dose of pain meds, call the surgeon today and advise. Most of the time every 8 hr dosing of the pain meds (gabapentin for nerve pain, diazepam to relax muscles does the job. Let your vet know what you observe and in relation to his next dose of meds to see what adjustment can be made to provide full comfort from pain. The post-op temporary pain caused by the surgery itself may last for about 14 days. Learning to express the bladder is a new skill. If you ever took piano lessons, you know you did not learn that new skill in a few days. Don't hesitate to go back for another hands on top of your hands lesson to learn the pressure to apply. Learn where the bladder goes as it empties and how to bring it back into your grasp. There is no one technique in expressing. Find the position and the hands/finger technique that you can do. For example my lesson was from a tall, large handed surgeon. I had to find a different position to do my best job of expressing. Watch this video and see different techniques, tips and ideas for expressing. Check out expressing for bowels. It is so easy you DO NOT need a vet lesson for it. dodgerslist.com/2020/05/05/bladder-bowel-care/
While learning the bladder expressing skill, expect to express every 2-3 hours to keep him dry. As you learn to feel his bladder and can pretty much empty it til it's quite flat, you can move up to every 3-4 hrs, then every 4-6 hrs and even over night. While diapers and such are typically saved as a last resort, with Gus' situation of loose bowel sphincter you may want to try baby diapers from the grocery store which you would check/change for urine change every 2-3 hours or for poop. --- Use a non-zinc barrier cream to prevent urine rash and broken skin from developing. Same care a baby gets. Non-zinc barrier creams: Aquaphor Baby, Aquaphor regular Healing Ointment OR Bayer's A+D® Original Ointment Keep skin and fur clean of urine and feces with non-scented baby wipes. --- A stack of dollar store washcloths and cooled green tea can help daub away body waste. This tip below and many other good ones comes including how to set up the mattress system for easy maintenance 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 your Gus best you can adjacent to his suite. Marjorie's tip: Brew up a pot of decaffeinated green tea. Let it cool, dampen a 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. If you can avoid a bath. A wet soapy slippery dog is an accident waiting to happen If you must.... Place a non slip traction mat on floor of tub or shower stall. Use hand sprayer to rinse off tough body waste stuck to fur. White vinegar in a spray bottle to disinfect and remove the urine ammonia smell from linens, floors and other hard surface. You'll use alot of white vinegar. Most cost effective is to buy at big box stores by the gallon such as Costco, etc. RECOVERY SUITE You may find either an 8-panel wire ex-pen or a baby's Pack N Play to be easier to access and care for Gus.
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Post by Chris & Gus on Feb 6, 2023 18:23:33 GMT -7
Thank you so much! We tried the diaper and it definitely helped get us through the night. One other issue is that when try to do our small at home PT lessons, Gus is super lethargic (obviously from his multiple meds) but it is difficult to get him to sit up and do some of them for more than a few minutes. Is this normal?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,528
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Post by PaulaM on Feb 6, 2023 21:00:28 GMT -7
Chris, good to hear you were able get through the night. Tell us, how you doing with the bladder expressing? What about poop expressing? Regarding Gus' daily PT, are you saying he is not able to push up to sit on his butt with the front legs. He is not able to support his upper body with the front legs long enough for you to do PT for the rear limbs? Such as bicycles? Take a look at the various post-op exercises to see what can be done in the lying down position. Post-op PT for the paralyzed IVDD dog: Gus' med list for a 35lbs dog doesn't look unusual. However, every dog is different about the combo/dose of meds. So if he is too lethargic, do call the surgeon and report what you observe. It may be the surgeon will have a suggestion about adjusting the meds. Let us know what the surgeon says.
Tell the surgeon about Gus overflowing bladder throughout the day. The roll Phenoxybezamine plays in helping you to express is to relax the neck of the bladder so it is easier to get a release of urine when you press on the bladder. Maybe the Phenoxybezamine is something to adjust? Also maybe you aren't able yet to empty the bladder enough, so it ends up filling very quickly and overflows.
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Post by Chris & Gus on Feb 7, 2023 11:50:17 GMT -7
Paula -
We did really well the other day with the bowel expressing. However, last night, we were unsuccessful before bed, which led to an overnight accident. We've narrowed down his bowel movements (the large movements, and not leaks) to around 3-4 hours post meal. So we intend to start attempting expression during this window in the mid-morning and post-dinner.
We are still not as successful with the bladder expression. When the Vet/Neurologist sent us home, my wife was able to express very easily. However, they informed us that he was extremely difficult, even for them. Hence the Phenoxy. We tried again this morning when he got up, but we were only able to get a small spurt and then droplets. About 10 minutes later, he had wetted himself in his playpen area for a large amount. We feel kind of lost on the urine. On the one hand, it seems that he has no issues emptying his bladder, but it has become an issue with constant clean up and ensuring he is clean and dry.
With PT, we sit on the floor with him in front of us (his back leaning against us to provide stability). We do the massage from toes to hips, and then bicycle kicks. Once we complete bicycle kicks, he seems to become agitated and attempts to "walk off" with his front legs. At this point, we don't want to fight him to avoid another injury - as he seemed to be in a little discomfort after an episode where he tried to get away this AM.
Also, we've begun to notice that his hind limbs, specifically his paws and lower below his elbow seem to twitch through the day and after therapy sessions. We know this is involuntary and not neurological, but should we be worried, encouraged, or indifferent?
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Post by Romy & Frankie on Feb 7, 2023 14:36:34 GMT -7
Good plan, doing the bowel expression during the window he would most likely poop naturally has the best chance of working Expressing is a skill and has to be practiced before it is learned. Many of our members struggled with expressing. I definitely did. I had to get more than one hands-on lesson from the vet, and I was afraid I would never learn. For me, practice made perfect and eventually I became proficient. What might help is expressing more frequently. Because it is early days, and you are not getting all the urine out, get what you can, out take a little break and try again in a short while. If you think that Gus tenses up his stomach muscles, making expressing harder, wait until he relaxes, so you can feel for the bladder. A warm towel from the dryer on the stomach can help relax him when you are just learning. Tapping gently on the tummy to jiggle the muscles will also help relax a tight tummy.
Some dogs are just harder to express. For those dogs, medicine like Phenoxybezamine should help. Let your vet know about the problems you are having and see what he says. Perhaps a change in medication would work better for your Gus. |
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