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Post by Kelly & Garvey on Nov 9, 2023 8:45:56 GMT -7
[Original subject line: New dog intro]
I have a four year old chihuahua/terrior His name is Garvey. On Monday October 23 I took him out for his daily walk. When we got home Garvey was unable to climb the stairs into the house I took him to the vet that day. He had bloodwork and spinal x-rays done, given gabapentin and ordered two weeks of strict rest He progressively declined to where he was having breathing problems and we had to take him to the emergency hospital On Thursday
10/26/23 he had an MRI which showed IVDH at L2-L3 causing compression of his spinal cord with hemorrhage He had no feeling in his toes Later that same day he had a hemilaminectomy
He was given a 50% chance for regaining sensation/movement in his legs He was discharged home on Sunday 10/29/23 and placed on strict bedrest for six weeks His medication consists of the following Prednisone 5mg every 12 hours, Gabapentin 100mg every 8 hours, Trazodone 50mg every 8 hours Methocarbamol 500mg every 8-12 hours and Prazosin 1mg every 8 hours
We received exceptional care at the VCA Animal Specialty Group His neurologist Dr. Olyphant was amazing I did feel however we we're ill prepared for the level of care required including bladder expression, administering meds, exercise restrictions, repositioning, incision care, bedding and housing We were completely unprepared
The first two weeks was beyond challenging Alot of tears, sleepless nights and questioning whether we were doing the right thing Nobody told us we wouldn't be getting the same dog prior to the surgery
He had his two week post-op visit on Monday 11/7/23 We were so distraught for a brief moment we considered euthanasia I am greatful Dr. Oliphant was understanding and supportive We adjusted his meds increasing his Gabapentin and Methocarbamol which has helped substantially and we have started to get the hang of it strictly through trial and error There's more sleeping and less crying And thats a win in my book
Prednisone 5mg every 24 hours daily
Gabapentin ▲200mg every 8 hours daily
Methocarbamol 500mg every 8-12 hours daily
Trazodone 50mg every 8 hours daily
Prazosin 1mg every 8-12 hours daily
[MED LIST/HISTORY- Moderator's Note. Please do not edit
10.2kg/22.49 lbs 4 y.o.
10/29 surgery with no deep pain sensation
10/30 discharged
11/7 two wk check up: no DPS in rear legs
prednisone as of 10/30 5mgs 2x/day for 9 days. 11/8 taper doses
gabapentin 200mgs 3x/day
methocarbamol 500mg 3x/day to prevent excessive movement
traZODone 5 mgs 3x/day
prazosin 1 mgs 1x/day]
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Nov 9, 2023 10:53:04 GMT -7
Welcome! My name is Paula, what's yours? Oh boy, IS it hard when blindsided with all new things and a disease one is not familiar with! I'm sorry you had to figure things out by yourself. So kudos to you for making the choice to stick with Garvey to ensure he has the best possible post-op outcome. We are glad you are here now. There is alot we can share with you. I'm sure you have Garvey's graduation day from strict rest marked on your calendar for December 7th. On that day we will have LOTs of information to gradually reintroduce him back to family life in a safe way. I hope Dr. O. was able to fully impart that nerve healing can be a slow process. It is still SO VERY EARLY in the slow nerve healing department at 2 weeks post op. Read more to internalize and know that Garvey is still the same loving fella whether he walks or needs a cart to assist while waiting on more nerve healing to happen after the 6 weeks of strict rest. 👀 dodgerslist.com/most-asked-disc-disease-ivdd-questions In the meantime, please fill us in a bit more on Garvey's care. 1) methocarbamol which are you actually giving: every 8 OR 12 hrs? What dose in mgs?
Prednisone: what date is the final every other day taper dose?
2) Most often it takes about 14 days for all the painful post-op swelling to subside. It seems it may be taking Garvey a bit longer. Please keep us posted that all pain is currently fully under control night and day with prompt and consistent gabapentin 200mgs 3x/day AND methocarbamol ? mgs dose every 8 (3x/day)? or are you doing every 12 hrs?3) At the 2-week neuro appt, did the neuro say if deep pain sensation had come back?4) Does Garvey stay dry in between expressing sessions?
How often do you express the bladder? Are you expressing for poop? Have you tried expressing for poop? Expressing for poop is so that before mother nature would just let it plop out anywhere, you get there first to encourage poop to clear from the digestive tube to plop out where you desire. Most of us express on the toilet: upon awaking in the morning, maybe at 1-2 pm during the day and again before bedtime. First you should make a chart of eating, poop plopping times and try to figure out when you should be expressing for Garvey's poop schedule. You really do not need anyone to demonstrate how to express for poop. This video shows how easy it is:
5) What at-home PT for the paralyzed legs are you doing? Which of these demoed in video below? Appropriate physical therapy can help maintain those muscles with lost nerve connectionand keep the joints flexible while nerve cells regenerate.
Post-op PT for the paralyzed IVDD dog:
We are all about helping owners to learn the tips and tricks for at home care of the IVDD dog. Your own self education will play an important part of that care for the now and for the many happy years ahead with Garvey. You will become more IVDD savvy to be able to ask necessary good questions and understand any medical treatment prescribed. You can learn more about us and the vets who help us make Dodgerslist the right place for all IVDD dog owners: 👀 dodgerslist.com/2020/04/20/education-team-ivddI know you will want to read the links we point you to in our posts. But also take it upon yourself to mosey on over to the Dodgerslist Website 👀 www.dodgerslist.com 👀 to do some more reading in the coming days so you become the IVDD knowledgable pet parent Garvey will be depending on. Order our free literature to help other vets tips & ideas for home care. Carry our wallet cards to inform pet parents of IVDD prone breeds you may meet. |
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Post by Kelly & Garvey on Nov 9, 2023 12:05:38 GMT -7
Hi So happy to meet you and to have this forum It would have been extremely beneficial if I had been given these resources before we brought Garvey home So to answer your questions
Starting 11/8 Prednisone was was reduced from 5mg every 8 hours to 5mg every 12 hours for 14 days
On 11/21 decrease to 5mg every 48 hours until 12/4/23 then stop med
As for the Methocarbamol he gets 500mg every 8 hours daily
Here's his post-op diagnosis Post-op Left L2-4 hemilaminectomy 10/26/23 secondary to acute IVDH at L2-3 and hemorrhage up to L3-4 • Paraplegic deep pain negative- static nociception, improved PL reflexes
He has no bladder or bowel functions however I am using a male wrap with a pad and I have to change it frequently because he appears to be peeing alot even between expressing
Lucky his stool is solid and just falls out on it's own He has 3-4 bowel movements per day
What I didn't mention is that I've been an RN almost 30 years so I have been repositioning him every few hours and range of motion frequently I gave myself the nickname MacGyver Mom I've discovered some amazing ways to make his tasks easier We could tell the day he came home he was annoyed His personality was not the same but I think he's starting to slowly get used to our new daily routine and he's not fighting everything as he was before
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Nov 9, 2023 13:27:34 GMT -7
Kelly, thanks for explaining more. Still a few things more that would be helpful for us to know. How much does Garvey weigh? For a small breed dog a full 500mg methocarbamol tablet would be WAY, WAY too high a dose. Please double check your bottle to verify the neuro Rx'd a full 500 mgs every 8 hrs. At the 2 week check up, did the Neuro say if the ability to sense deep pain (DPS) had returned?
Nerves heal typically in the reverse order of the damage to the spinal cord:
1. 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 identify neuro function.
2. Tail wagging with joy at specifically hearing happy talk, seeing you or getting food.
3. Bladder and bowel control that dog can actually "pee" on their own verified with the "sniff and pee" test.
4. Some Leg MovementGarvey's overflowing bladder could be due to several things. 1) Prazosin relaxes the urethral sphincter to make expressing easier. Let the vet know Garvey's bladder is overflowing a lot between expressings. Prazosin may need to be adjusted? How often are you ACTUALLY giving 1mg Prazosin?
2) The goal is learning to express is to be able to feel the bladder to know when it has been practically emptied. HOW often are you expressing? Don't hesitate to return to your vet or neuro's vet tech to get another hands on top of your hands type of lesson. Video for tips and techniques in expressing. ==> dodgerslist.com/2020/05/05/bladder-bowel-care/3) Prednisone makes them more thirsty and thus bladder fills and overflows.While on pred AND you are learning to reach proficiency in fully expressing the bladder each session, you may need to start out expressing every 2-3 hrs. Then as he stays dry, you move up to every 3-4 hrs. Eventually you will find he stays dry at every 4-6 hrs and even 8 hours over night til morning. Range of motion is excellent. But that is just one part of caring for the legs. Do watch the video in above previous post for how to make the muscles fire, weight bearing for bone health, etc. Is Garvey not at all able to do some repositioning of his lower body on his own by using front legs, etc? |
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Post by Kelly & Garvey on Nov 9, 2023 16:06:09 GMT -7
He was getting a lower dose of Methocarbamol but he was still getting really restless and anxious with any activity so he is getting the Methocarbamol 500mg every 8 hours daily
His currently weight is 10.2kg [22.49 lbs]
At his two week check up [11/7] his DPS was still absent
I am giving the Prazosin 1mg once a day at 6am
We take him out several times a day and lift his back legs with a sling and express his bladder until no more urine comes out
He can stand on his front legs but he has no movement to his lower legs or tail When he is outside we lower his back legs to the ground using the sling to try muscle strengthening He is unable to reposition himself using just his back legs but instead he attempts to throw his body using his head and front legs That's one of the reasons we increased his Methocarbamol I reposition him and take him outside several times a day
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Nov 9, 2023 18:11:45 GMT -7
Kelly, what does several times a day mean in hours? Do you express every 2hrs, 3hrs, ?The goal in expressing to be able to feel the bladder in all the stages of emptying. When the Bladder is very full, it takes little pressure on the tummy area to make urine release. As the bladder reduces in size, it takes actually capturing the bladder in between both hands so that pressure can be applied. Expressing is just a matter of physics. The pressure in the bladder due to expressing has to be greater than the force of the urinary sphincter to stay closed. When urine no longer comes out is not enough information to know if the bladder is really pretty empty. The concern is always to prevent a UTI if not expressing often enough and fully voiding bladder. Can you tell us you are able to feel the bladder as it gets smaller and smaller to the point it is pretty empty? That means you can almost feel the fingers of your other hand because the bladder is so flat. Oh so methocarbamol 500mgs 3x/day for a 22.49 lb dog is not being used wholly (or maybe not at all) for pain? But rather to over relax his muscles to prevent him from too much post op-movement? --When out in his rear sling, is he able to walk normally with front legs? --Or are the front legs a bit uncoordinated or unsteady?
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Post by Kelly & Garvey on Nov 9, 2023 18:32:43 GMT -7
I express at least every 3 hours I stop when I can't feel his bladder anymore and his belly looks flat also if I continue to press his penis comes out He can stand fairly steadily on his front legs he has also started to try taking steps when we hold up his back legs with the sling
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Nov 10, 2023 10:18:45 GMT -7
Kelly, you can imagine when we can't see what you see, how much we depend on the exactness of your words. It is too easy to wrongly assume. That is why we ask everyone for specificity in wording.
What does this sentence mean? "He can stand fairly steadily on his front legs he has also started to try taking steps when we hold up his back legs with the sling"
Are you saying with rear sling support his back legs attempt to move in a walking motion? Any rear leg movement during potty time can be due to reflexes.
Let us know if you are seeing back leg movement outside of potty time whether that be attempting to:
--- use back legs to reposition in his recovery suite
--- sling walking other than when at potty times.
There too many unexplained variables, to be able to pinpoint to just one reason why so much leaking between expressing.
If you are expressing every 3 hrs until the bladder goes pretty flat, then there is some other reason for his leaking a lot in the diaper.
-- You may believe the bladder is flat because you have not reached the expressing skill proficiency of ability to feel the bladder in the flat stage. If that is the case, then try expressing every 2 hrs while continuing to increase your expressing skill. When the bladder has been emptied, it increases the time before needing the next expressing. As your skill level increases eventually you will be able to move up to every 4-6 hrs and even 8hrs during the night.
-- could be Prozosin dose needs adjusting so the neck of the bladder is not so easily opened to release urine by Garvey normally moviing around.
Also methocarbamol relaxes muscles. The high dose of methocarbamol (500mgs 3x/day for 22.5 lbs dog) may be a contributing factor for leaking between sessions???
For example my 17 lbs dog took 125mgs methocarbamol 3x/day. This dose by weight is pretty commonly Rx'd for muscle pain throughout the multiple thousands of dog on this Forum.
The important point while learning to express, is that it is not uncommon for a UTI to develop as one is learning this new skill. Not all UTI's have signs. While other UTI's will show change in odor, color, etc. Your trained medical eagle eye will be of help in case a urinalysis seems like a reasonable idea.
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