Alexi's Toast 4/3 surgery?wks - pug -Denmark; GRAD?

Welcome!  Alexi, do I have your name right?  I'm Paula.  I'm sorry to hear your young boy was discovered to be born with IVDD.  It is pretty typical that about 4-7 years old is when owner and vet first learn with usually signs of pain or even some neuro diminishment. It is thought there is a genetic component to IVDD. I tell you this because some dogs will only have one disk episode their entire life. While other dogs might have multiple so you would want to know all you can about this disease while you're getting ready to have toast come home. This is your chance to bone up on his disease and learn how to set up his recovery suite to make the surgeon directed post-op rest go smoother. And to be watchful about his sister....are these two genetically related?

Shortcut Thru IVDD: dodgerslist.com/2020/06/26/time-and-ivdd/
Many tips and ideas to get ready for Toast's homecoming and post-op rest:  dodgerslist.com/2020/05/14/strict-rest-recovery-process/

I bet your mind is flooded right now with concerns, questions. Now is the time to jot those things down. Here's a starter list of questions to which you can add some of your concerns to ask your surgeon: dodgerslist.com/2020/06/03/discharge-day-list/

This page is good reading by Dr. Isaacs, ACVIM (neurology) as he explains many post-op questions for our IVDD community: meds, crate rest, PT and discharge day. dodgerslist.com/2020/05/12/dr-isaacs-surgery-answers/

Let us know too anything else we might specifically comment on to ease your mind, make care easier, etc.

As you learn more from the surgeon, would you keep us updated on how Toast is doing post-op.

What country are you in?

Alexi, we look forward to whether Toast will have bladder control or not on discharge day to know what home care would look like and what to comment on for you.

 Finger's crossed he'll have bladder control.  As for leg nerve healing, we know the predictable order but not the length of time for nerve healing. That is up to mother nature, and Toast's body. Often just the surgery, can cause temporary nerve function setback until the surgical caused swelling subsides in about 14 days. Then one can better see the path of healing.  Nerve function first starts with ability to feel deep pain sensation (DPS).  Did the neuro say if DPS is now back post-op? Or maybe he never lost DPS going into the surgery?


Are your work situations such as to allow one of you to come home for lunch/potty break for Toast if needed? Once we know exact Toast details when he's discharged, we can put our heads together with yours to formulate a doable plan for at home care..

This is a bump in the road of life for sure. Your love for Toast will get you through this, that I have no doubt of.

We look forward to receiving your next update on Toast

Alexi, Toast is only on one  pain med Pregabalin (for nerve pain).  There are other sources of pain, so have no patience if further signs of pain occur.  Call the surgeon's office to report pain and expect an addition of another pain med.  Onsior, the anti-inflammatory may take up to 2 weeks to get all the surgery caused swelling to resolve.  In the meantime, Toast needs to be able to heal in comfort right away with adjustment to his pain med.

See if in Denmark, they will protect the GI tract when on an anti-inflammatory.  Pepcid AC (Famotidine)  Learn more including the dose. dodgerslist.com/2020/05/06/stomach-protection/ 
thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg 

Did the surgeon himself say Toast has DPS?  
  No need of pinching the toes. DPS indentification is very tricky for a DVM. Trust only the specialist surgeon.  You likely will not learn anything from pinching.  Tickling toes on the other hand can be part of the passive exercise!

Always give Toast first a chance to sniff an old pee spot on the balcony. If nothing comes out when you know he should have to pee then express.

How comfortable would you feel with an ice cube on your butt hole?  Try a kinder way of 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. You really do not need anyone to demonstrate how to express for poop. This video shows how easy it is:

Alexi, when you are able, update and confirm a few things that we might best follow along and make good comments.

For how many weeks did the surgeon direct for post-op rest which does include his directives for PT. Often the post-op rest can be for 4 or 6 weeks.

What type of PT at the Physio.  Do discuss underwater treadmill.
    The movement of the hip joints and muscles and the changes in pressure on the paws from the underwater treadmill triggers spinal cord communication with the brain. Water buoyancy makes it easier than leg movements against gravity. There is not only the potential to regrow damaged neuronal path ways but also for neuron to muscle re-education to learn the art of walking again.

So it  sounds like you are reporting Toast was discharged with ability to pee on his own (has confirmed bladder control)? Evidenced by:  At home he could hold urine in, until saw his pee pad then began to pee since being discharged on Sat 4/6?

It is frustrating for sure.  Continue to observe for his showing you evidence of still having bladder control (can pee by direction of his brain).  VS having no bladder control (releases urine by reflexes when lifted, urine found where he sleeps due to an overflowing bladder.)
--- some UTI's don't show an odor. Some might show a change in color. Some bladder infections cause painful burning sensation making the dog not want to pee.
--- A urinalysis screens for bladder infections and shows if there is a need for an antibiotic.

Always give him a chance to pee on his own when you know he should have to pee.  IF nothing happens, try again in an hour.  At that point, you might be able to help him relax his tummy muscles by applying a warm towel from the dryer. Jiggle his tummy gently too. Maybe then you can try to express with success.  Know that a dog who has bladder control will not like you expressing and will likely resist your efforts.

I hope you will get a good night's rest and feel up to using your powers to deal with events of the day.  Once you get a new routine established, your world changes for the better.

Paula (NY  EST Monday 4/8 5:44pm)

Alexi, so the surgeon group did see him pee on his own 4/9? (that means they did not express, but allowed him to release urine on his own.)  If so, good to know then that he still has bladder control. Hopefully covering possible pain from the surgical caused procedure by giving a Fentanyl patch will give full comfort from pain.

What is the length of the patch effectiveness. Is it a 3-day patch or ....?

Let us know how Toast takes to the underwater treadmill tomorrow (Thurs 4/11).

Oh... could you help us out?  No need to quote our questions when answering.  Just include 1-2 ref words in your own sentence. Thanks!

Alex, Oh, the surgeon did not get him to pee, he got him to release urine by expressing...that paints a very different picture for us.

you really need to verify if he really has bladder control and thus you may use the proper term of "peeing."  Or has he lost bladder control and then leaking on you when lifted is "overflowing" due to reflexes allowing urine to escape.

Toast needs a barrier cream to prevent urine staying on his skin, just like babies need a barrier cream to prevent urine caused rashes.  Can you obtain baby products with no zinc:  Aquaphor Baby, Aquaphor regular Healing Ointment OR Bayer's A+D® Original Ointment?   

What about asking for a urinalysis to proove if there is a bladder infection going on that could cause dribbling, a painful burning sensation. Sometimes a bladder does not show outward signs for us...the urinalysis gives proof one way or the other.

I can't remember, on discharge did the surgeon himself tell you if Toast had DPS?

Poop will always come out on it's own. So that is not proof he has bowel control.  Control for poop, means the dog won't poop where he sleeps unless he is not taken out in time.

First try a peed pad every 2-3 hrs.  IF nothing, then try to express for urine. 

Did you get a hands on top of your hands type of expressing lesson? Or just observed someone doing it?  A hands on is a MUST to know the amt of pressure to apply. Where the bladder goes as it get small.  It can take a weeks worth of expressing to become proficient.

This not knowing for sure if he's got bladder control (can pee) or loss of bladder control (bladder overflows) is confusing for you and me.

Alexi only trust the word of the surgeon about DPS. General DVM vets and other veterinary persons often get DPS wrong! On discharge or the last time you saw the surgeon, whether he had DPS should be in the notes on file.

The reason to know DPS is that is must first exist for nerves to further heal. Even a dog who had no DPS this neuro function can come back with time. Same as all nerve healing it takes time.

With loss of bladder control, a dog must either be manually expressed or there must be use of a cath.  Stagnant urine remaining in the bladder, can quickly become a breeding ground for bacteria. The urinalysis will prove if an anti-biotic is needed or not.

If need be you and James bring Toast in to your local vet so that you can get a 2nd hands on your hands lesson.  Expressing is a matter of practice.  Make sure he has had a drink of water an hour or more before the expressing lesson.
**
Do you feel the bladder each time you express? Do you keep pressing until the bladder feels almost flat, like your fingers are almost touching? If the bladder has slipped away, you'll need to find it again and keep expressing until it's completely empty. It often slips back by the pelvic area. When the bladder is completely full, you won't really feel it as it fills the whole abdominal cavity but as it empties and gets smaller, you should be able to feel it.

Here's what the Dodgerslist page on expressing says about this:

"The bladder varies in size, shape and position depending on how much urine it contains. As the bladder shrinks, your hands move inwards gently, with a consistent pressure. As the bladder gets smaller, cup your right-hand fingers to trap the slithery bladder. Use your pinky to find the bladder hiding back in the hip/thigh area. Slow, gentle, consistent pressing is not painful to the pup."
==> dodgerslist.com/2020/05/05/bladder-bowel-care/

HARD to Express dogs
Dr Isaacs, DVM, Neuro (ACVIM) speaks to this and drugs that might help:  dodgerslist.com/2020/09/02/tense-during-expressing

Another neuro surgeon Dodgerslist consults with explains expressing:

What a wonderful update you've given today, Alexis! Such good news of the signs of nerve healing that you've seen - return of bladder control and improvements in leg movement. Excellent to see this so soon following surgery.

Glad to hear that the Pepcid AC has helped with his gas pain. What dosage are you giving and how many times a day? Please continue to give the Pepcid AC for as long as Toast is on any dosage of Onsior.

I well remember my Jeremy's legs also making a clicking sound as he began to move them again. It was not problematic at all and eventually stopped when he regained movement. I do hope that this will be the same for Toast. Please let us know what the vet thinks. Here's a link to Dr. Isaac's response to this question that you might like to discuss with your vet:

dodgerslist.com/2020/08/20/spine-popping-sound/%E2%80%8B?highlight=popping

Keep up the good work with Toast and please do continue to keep us updated.

Healing prayers for Toast.

Alexi, what is Toast's progress so far with underwater treadmill? What did they observe as his most current leg use ability? We'd like to know what your 4/18 report "2) massive improvements with therapy and movement" translates to in actual eyeball observations.

Let us know what this shock therapy is actually called.