Jessica's Mocha 2/15 surgery4wks - Chi/Dox GRAD 3/24

Jessica, welcome to the Forum. We are glad you are here. The resident neuro explained well the importance of STRICT rest so that the disc can heal.

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.
◼︎no PT for conservative dogs during 8 weeks to heal disc
◼︎ avoid dangerous detours. Follow the "Roadmap." Tape it to your fridge. D/L and print out: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdf
 
POTTY TIME strictness
    Carry your dog to and from the recovery suite out to the potty place and then allow a very, very few limited footsteps.
    Uss a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over.  Allow no dragging around at potty time.  Limited footsteps means limited movement of the spine.  With each footstep the vertebrae push on that bad disc.  



MONITOR for  NEURO FUCTION--- Keep your vet/neuro alerted
As damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if  there excessive back/neck movement for example.
1. Pain with initial tear of disc and ensuing swelling
2. Wobbly walking
legs cross
3. Nails/toes scuffing floor
4. 2/15 rearPaws knuckle under. Dog is slow to correct or can't right the paw(s) at all
5. Weak/little leg movement,
   2/15 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 when specifically doing happy talk or treating.
9. ___Deep pain sensation (DPS), the last neuro function, 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.
    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.
        Precious hours can be lost with a general vet who gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS.

A definitely a must read for you:
A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/2020/02/10/surgery-vs-conservative/

It is possible that the disc  can now heal with your employing strict rest.  The disc takes 8 weeks to heal. Nerves may or may not heal in that short of time. Best to think in terms of month rather than days/weeks for this slowest part of the body to heal.

What kind of recovery suite do you have for Mocha? These are the tips you will need to make the next 8 weeks of rest go smoother:  dodgerslist.com/2020/05/14/strict-rest-recovery-process/

While neither you nor your DVM local vet can likely correctly ID lost DPS, you can definately know when inabllity to do a happy tail wag is lost.   That is the point you will have to decide on a surgery or to continue on with conservative treatment. 

PAIN
Let us know if just the one pain med (gabapentin for nerve pain) controls pain round the clock, night and day.
    Resolution of spinal cord inflammation/swelling provides the relief from pain. It can take an anti-inflammatory carpfrofen a range of 7 to 30 days before all swelling is gone. 

[corrections to Mod 2/14 Med List:]
- The trazodone is 1/2 to 3/4 of a tablet as needed for separation anxiety every 12 hrs. The last time he had it was on Sunday 02/12 and he had 3/4 of a tablet. 
- Xanax is as needed, .25 mg every 8 hrs, last time he had it was Sunday 02/12.
- Zoloft also for separation anxiety, he takes 12.5 mg 2x/day.
- He has been on the carprofen since 02/09 evening.

He was admitted [2/14 night] to the ER at Animal Medical Center in NYC tonight after we brought him in due to inability to stand. He could wag tail. They said his brain is still able to send messages to his feet but it is weak. His right leg is more affected by the herniation and they suspect it has gotten worse since [2/14 morning] this morning even though he was on strict crate rest. They said there is pain also.

While he was in the crate he was sitting and barking due to activity in the apartment.

They are going to let us know [2/15] in the morning if he is a candidate for surgery. An earlier Xray from 02/06 - before this episode - showed mineralization in multiple dics but there was no pain or symptoms.  --Jessica

The ER called us this morning and said because he still has feeling in his back legs, he is a candidate for surgery. He is getting an MRI this afternoon and if it goes well, they will proceed . They warned of a fatal complication involving extensive spinal bruising that he is not showing signs of.

Jessica

We have been told he is now going into surgery. He has an extrusion that compressed his spine. There are other sites (I think they mean mineralization) but they are not effected.

We are told his surgery is successful, they removed a lot of material that was compressing his spine. We are getting a more complete update tomorrow. He is resting comfortably in his crate

This is what Dr said - Mocha did well overnight and rested comfortably. This morning he remains non-ambulatory, however has improved motor function in both back legs. His incision looks great and we are watching him closely for continued improvement. We will transition him to oral pain medications today and prepare to send him home tomorrow.

The hospital told us Mocha was able to stand and walk a few steps with assistance this afternoon, and also take a few steps unassisted ie "weakly ambulating." If he is the same or better tomorrow, he is getting discharged likely in the afternoon. We just hope he continues to make progress and does not regress. He is still very far from normal. They mentioned also because he has motor function in the rear legs he should be able to pee and poop on his own.

He also has had a full appetite and is wagging his tail. He is on codeine, gabapentin and trazodone - we do not currently know the dosage.

Should we expect regression when he comes home? I live in NYC where there isn't much grass, and am having him convalesce at my parents' house upstate with a yard until he hopefully gets stronger.

He is a very active boy with pretty intense separation anxiety. So I in turn have anxiety about getting him to remain at peace in the crate to heal. I noticed when we were trying to get him to rest before the surgery, he stood up in the crate and pawed at the door. I worry he could also try to dig his way out. How damaging could that activity be? He cannot jump or stand on his hind legs in the crate. We are also getting trazodone from the hospital.

Jessica

I will be caring for him until Sunday 02/19 when I have to go to Florida on a work trip through Thursday or Friday that unfortunately cannot be moved. My husband and mom are planning to come with me to his discharge meeting today, so they can also get full instructions for his care while I'm gone. After a couple weeks of recuperation, he will finish his rest period in NYC with us.

Mocha has been discharged from the hospital. He is weakly walking with some knuckling under of his rear paws, particularly his right paw.
We are with him at my parents’ house now.
He took a few steps to go pee outside this morning, he has not yet pooped.

His was prescribed
7.5 mg codeine every 8 hrs for 3-5 days,
50mg trazodone as needed and
100 mg of gabapentin every 8 hrs for nerve pain. This is in addition to
12.5 mg Zoloft 2x per day. He is also cleared for
Xanax as needed.

[MED LIST/HISTORY- Moderator's Note. Please do not edit
14-15 lbs    3 y.o.
2/15 surgery
gabapentin 100 mgs 3x/day
codeine 7.5mgs  3x/day til  2/22
traZODone 50mgs
xanax 0.25mgs 3-4x/day (not used)
zoloft 12.5 mg 2x/day ] 

We are also starting to do at home PT.
He is having a hard time acclimating to the crate and I think this will be the hardest thing, lots of barking, whining and crying. He also stood up to try to get out and pawed at the door of the crate. Normally he is under foot and he has separation anxiety anyway. Any suggestions would be greatly appreciated.

The script for Xanax is for .25mg every 6-8 hrs. We have not given him the Xanax since his surgery and are not giving him max trazodone either.

They said a total of 4 weeks strict crate rest. He is only allowed out of the cage for PT and pee / poop. They said he should be assisted with a sling but the last few times we took him out he could pee and poop on his own and as soon as he was done we picked him up and brought him inside.
    For PT they recommended flexing and extending the joints of the rear limbs 5 minutes 3 to 4 times a day, swaying the hips side to side while standing for two minutes 3 to 4 times a day, tickle the bottom of his feet and bicycle foot to floors, three sets two times a day. He could also go to PT at the Animal Medical Center
We haven't fully done all of these yet, some of the side to sides, and the tickling his toes. I am a little worried about over exerting him given that he is walking slowly outside for bathroom breaks and the most important part of his recovery is strict crate rest

It's a good idea to take it slowly. However, the surgeon has given the OK to do these passive exercises so you should be able to go ahead with them. If you feel that Mocha has any pain that is causing you to be reluctant to do the exercises, please do advise the hospital ASAP so his meds can be adjusted. The walking slowly could be due to weakness or nerve damage or it could be a sign of pain. Do you see any other sign of pain to confirm?

◻︎ restless, pacing, can’t find a comfortable position
◻︎reluctant to move much in crate such as shift positions
◻︎shivering-trembling ◻︎yelping when picked up or moved
◻︎slow to move ◻︎tight tense tummy
◻︎arched back, ears pinned back ◻︎ head held high or nose to the ground.
◻︎looks up with just eyes and does not move head and neck easily.
◻︎ not eating due to pain of moving jaw with a neck disc or pain of back disc
◻︎ holds front or back leg flamingo style not wanting to bear weight
◻︎not their normal perky selves

Strict crate rest is not as strict post-op as it is with conservative care. Post-op crate rest is to allow the surgery site to heal. The disc that was pressing on the nerves of the spine has been dealt with through surgery. During the directed healing period, PT is eyeball-to-eyeball supervision, slow and deliberate practice. Then back to the recovery suite to allow all the surgical sites of muscle and bone to heal. With dogs who can walk, often the supervised and controlled walk to and from the potty place is part of the surgeon-directed PT.

If you have any questions or concerns at all, don't hesitate to contact the hospital. Any vet there can pull Mocha's records and give you answers. As always, we're here for you and Auggie, too. But the surgeon knows best as he was the one who did the surgery, so do reach out to them should you have concerns.

Hi,

Would like to give an update on Mocha. He is in the care of my mom in upstate NY where she has a lawn and grass and between her and my dad, someone is home almost most of the time with him. He is either in the crate, tied up to a leg of a table or in bed 95% of the time.

He is a little over one month out from his surgery and is doing really well. We last saw him a week ago and I would say his walking is close to what it was prior to the disc episode, though not the same, and I'm so grateful.

We are taking him back to his surgeon in NYC on [3/24] Friday for his post-op check and then he is going to hopefully stay with us (his humans) full time.

I have a few questions about his return to NYC. Mocha has pretty bad separation anxiety, so when my husband and I are both at work (1-2 days per week) he goes to daycare. With permission from the surgeon, and instructions to the daycare, would you recommend a return? I am thinking of switching his daycare to a place where the small dogs are segregated from the big and there are only a handful of dogs in the room at the time.

We know Mocha has other calcified discs. Prior to this episode, he was basically a full blown nut, jumping on furniture, beds, at the door when we left, running, having 'zoomies,' taking five mile hikes. We know this is a thing of the past now but I still worry a lot about him having another episode.

Jessica

Mocha had his post op check yesterday.

They said he is doing well and is now functional. We are so grateful and he is back in NYC. The vets said he can have a gradual return to activity, building up to 20-30 minute walks at a time. Right now he's about at 5 to 10 minute walks with loads of energy. The surgeon also said we should have eyes on him in the apartment all of the time, or else he should be in a crate. He is doing okay on the hardwood floors as long as he isn't running but we put out yoga mats and exercise mats to help him walk.
He lost some coordination of his back legs due to the herniation and she isn't sure if that will return - something about his spinal channel. We could do physical therapy but the surgeon said it is not necessary. It could help strengthen his muscles to prevent another episode, she said. He is now off the 100mg of gabapentin 3x/day.
We know Mocha has other calcified discs. This is what a radiological exam before the disc episode found: "There is mild narrowing of the invertebral disc spaces between T11 and L1. There is in situ mineralization of multiple invertebral discs."
She said walking basically carries no risk of an additional herniation and it's good for him. We would like to resume his daycare at a significantly reduced schedule - maybe 1 or 2 days a week. She said that daycare is a riskier activity but ultimately it's up to us and he can have a "normal" life despite the disease. We would change his daycare to one that is a more professional operation where small dogs are kept in a smaller space. Otherwise we can figure out something else.
The surgeon said the literature says dogs with one disc episode on average are at a 20-25% chance of having another disc episode - basically I think she was preparing us to realize this could happen again. She said it may not be severe enough to require surgery. She also said disc episodes happen in younger dogs because over time in older dogs the outer layer hardens and protects more against another herniation. But she said we should be vigilant - and we were not at all before.
We're giving him cod liver oil, chondroitin and glucosamine and some supplements that claim to help with joints and back health. Plus we're planning to give him bone broth for collagen.
We would be grateful again for any of your tips, advice and feedback.

Jessica

Hi & Thank you so much. I made a posting with the details of Mocha's surgery but am not sure if it's in the right place. This is where I made the posting - dodgerslist.boards.net/thread/8997/surgery-animal-medical-center-manhattan
        [ Post was moved to:  dodgerslist.boards.net/thread/8997/surgery-recommendation-nyc-new-york ]
Let me know if I should move it. Thank you,

Jessica