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Post by Denny & Osito on May 14, 2024 11:21:24 GMT -7
[Original subject line: Denny's Osito 5/14 Conservative Boston/Dox mix; GRAD 7/9 ] Hi All. This forum was great in helping me deal with my first dachshund (Buddy) IVDD issues. Apparently I've got the same issues 20 years later with a different dog.
Osito is a Boston/Dachshund mix (13.4 pounds). We got him at age 4 as a "failed foster." In September of 2022 he had a bad IVDD incident and had to have surgery. He bounced back from the surgery brilliantly. We thought his genetics would shield us from IVDD. We reacted by installing ramps in the house and crating him when we're not home.
FF to [5/13] yesterday I could tell something was off. He didn't greet me with the same crazy energy he usually does.His pain will ramp up when he gets super excited (knock on the door). He has full use of all motor functions.
He went to his [5/14]vet this morning and they put him through a thorough exam that he refused to react to. This was a problem in 2022. No one wanted to do the surgery because they thought he didn't have deep pain in his legs. He does;he just won't show it. After his surgery he stood up on day 2.
Vet prescribed Rimadyl 25 mg every 12 hours and Gabapentin 100mg every 8-12 hours. My gut feeling is that we've probably got a bulging disc but not ruptured. I want to do conservative crate rest but vet didn't want to do steroids. Do I need the steroids?
[Moderator's note: please do not modify 13.4 lbs 6y.o. Rimadyl as of 5/14: 25mg 2x/day for 14 days, 5/28 TEST STOP for _pain __ neuro Gabapentin 100mg 2x/day Osito needs GI tract protector, Pepcid AC, on board for duration of Rimadyl! ]
![](https://i.ibb.co/4FRzWrd/calendar.jpg)
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Post by Romy & Frankie on May 14, 2024 13:32:52 GMT -7
Welcome back to Dodgerslist, Denny.
For a dog with full motor functions and whose only symptom is pain, Rimadyl is a good anti-inflammatory. Steroids are a stronger type of medicine than Rimadyl, whoch is an NSAID type. As long as Osito's motor functions do not worsen and his pain is under control, you may never need steroids.
How many days was the Rimadyl prescribed for ?
We have more information about steroids vs NSAID here:
Is Osito currently on Strict crate rest. The crate rest during conservative care is much stricter than post-surgery crate rest. It is the immobility enforced by crate rest that allows the disc to heal. Eight weeks of 24/7 crate rest, out only for potty or necessary vet visits, will be needed for this healing to fully occur.
More info on crate rest is here:
STRICT means: - no laps - no couches - no baths - no sleeping with you - no chiro therapy - no dragging or meandering at potty times
Carry Osito to and from the recovery suite to the potty place and then allow a very few limited footsteps.
You mentioned that Osito is sometimes showing signs of paiin when he gets super excited. How does this excitement manifest? Is he jumping up or moving a lot? How often do you give the gabapentin every 8 hours or every 12 hours?
All anti-inflammatories, like Rimadyl, cause excess stomach acid. This sometimes results in serious stomach damage. To lessen the chance of damage, a stomach protector like Pepcid-AC is used. Ask your vet if Osito has any health issues to prevent use of Pepcid AC (famotidine)? (doesn’t need it, we wait til there is problem…are NOT answers to your question!) If you get a “no health” issues answer, then go to the grocery store to purchase over the counter Pepcid AC containing one single active ingredient (famotidine).
The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound, 30 mins before the anti-inflammatory and thereafter every 12 hours for as long as your dog is on the anti-inflammatory. More information on stomach protection is at the link below:
It is very upsetting and scary when our dogs have IVDD. It becomes less so when we learn all we can about the disease. More information can be found at our main website: www.dodgerslist.com
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Post by Denny & Osito on May 14, 2024 14:02:45 GMT -7
Thank you!!!! Osito's pain manifests when he barks a lot. He literally goes insane when one of us comes home or he hears the door motion detector notification (I've since disabled it) I have two weeks of both drugs and at least one refill.
Rimadyl 12.5 mg (1/2 of tablet) every 12 hours for 14 days. Gabapentin 100mg [how often ACTUALLY given?] every 8-12 hours
both meds are refill as needed Thanks again!!!!!
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Post by Romy & Frankie on May 14, 2024 14:31:47 GMT -7
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Post by Denny & Osito on May 15, 2024 16:10:15 GMT -7
The Gaba is every 12. Osito is 6. Pain seems to be under control today,but he's a little loopy
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on May 15, 2024 19:34:00 GMT -7
Denny, good to hear gabapentin at only 2x/day is doing the job to keep Osito free of pain. As a refresher for you since the last disc episode was a surgery. Rest must be necessarily more strict than it was for surgery. The 8 weeks of rest is for disc healing and avoiding a relapse, starting from square one to heal the disc. CONSERVATIVE VS. SURGICAL CRATE REST
** ANTI-INFLAMMATORY during conservative treatmentThe anti inflammatory, Rimadyl, could possibly take 7 to 30 days to resolve all painful swelling around the spinal cord. Vets simply must guess how many days to use Rimady.. Often the approach is to RX a 14-day course of Rimadyl. At the Rimadyl stop on 5/28, the vet will learn from your observations if another course is needed or not. For many dogs, Rimadyl can do the job on a 14-day course. Fingers crossed that will do it for Osito.You job with the projected 14-day course of Rimadyl TEST STOP on Tues 5/28 is to monitor for surfacing pain.1) Let us know what you and your vet have for a PLAN B should pain arise when he's not open?2) Let us know on 5/28 if the single pain med, gabapentin, will also be stopped to give you a quick and accurate assessment about pain?RULE OF THUMB on Rimadyl Stop Pain= another course of Rimadyl + all pain meds, GI protector back on board.
No Pain= no meds at all needed... finish out the 8 weeks of crate rest for the disc to heal. This page is a good review of how Rimadyl is used during conservative treatment. This kind of knowlege allows you to understand your vet's treatment and ask good questions.
Also more about: 1) Protection against stomach acids Rimadyl causes. Dogs don’t speak up at first signs of trouble like a person would. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life-threatening perforated stomach. Pepcid AC ==> dodgerslist.com/2020/05/06/stomach-protection/ 2) Your options for a Plan B ==> dodgerslist.com/2020/04/18/steroids-vs-nsaids/
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Post by Denny & Osito on May 16, 2024 11:31:06 GMT -7
Ok looks like this is getting shifted to the post-op board. Osito saw Levine Veterinary Neurology in Sarasota today. An MRI revealed a neck disc issue. He's having surgery today and coming home tomorrow barring any complications.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on May 16, 2024 13:27:58 GMT -7
Denny as you learn more post-op, let us know how the surgery went and how Osito is doing.
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Post by Denny & Osito on May 18, 2024 16:32:58 GMT -7
Gabapentin 1.2 mil (liquid)every 8-12 hours Prednisone (starts 5/19 every 12 hours)
Osito came home [5/17] yesterday and everything was going beautifully.
Just now (7pm 5/18) he started experiencing a lot of pain. Then I realized between my wife and I we missed the second dose of gabapentin. I feel terrible. He went about 13 hours between doses.
post prior to surgery: Will do. These people did a bang-up job on him before so we are hopeful.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on May 18, 2024 17:58:59 GMT -7
Denny, I know what a quilty feeling that is. How about a med chart to keep the doses from being missed and gives a place to make notes. A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdf(After 5/20: dodgerslist.com/wp-content/uploads/2023/12/med-chart-printable.pdf)⚠️There will be a switch in classes of anti-inflammatory ( NSAID, Rimadyl to STEROID prednisone in 3 days starting 5/19. There normally needs to be a 5-7 day washout period when switching from a NSAID, Rimadyl to a STEROID, prednisone. However, should the surgeon deem it medically necessary (extreme pain, neuro diminishment) to switch w/o a washout, a switch can be made without a washout period by adding TWO stomach protectors:---Sucralfate marvistavet.com/sucralfate.pml---Pepcid AC marvistavet.com/famotidine.pmlPlease advocate for both Pepcid AC and Sucralfate. And learn their timing with food, with each other. The sample med chart referenced above will also give you an idea of timing meds. A bit worried about the upcoming switch. Please keep us updated. And monitor for GI damage signs : nausea (lip licking), not wanting to eat/drink, loose stool, vomit, bleeding ulcer, RED or BLACK blood in diarrhea. When things settle down, let us know: ---What is the gabapentin formula noted on the bottle: 1. How many mgs gabapentin in on mL of liquid? 2. How often are you actually dosing gabapentin. It is nice to know there is a range. But we like to know what you actually give. --- Prednisone as of 5/19: ?mg ?x/day
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Post by Denny & Osito on May 19, 2024 1:58:03 GMT -7
His last Rimadyl was 5/15 at bedtime so we are close to 5 days (the tech specifically mentioned the washout). I'm going to proactively give 5mg of ✙pepcid 30 minutes before his pred (it can't hurt anything,right?).
Gabapentin suspension 50mg/ml. Gabapentin 1.2 milliliters (marked on syringe) every 8-12 hours Prednisone tab 2.5 mg. Prednisone 1 tablet every 12 hours for 7 days then consult.
[Moderator's note: please do not modify 13.4 lbs 6y.o. Rimadyl as of 5/14: 25mg 2x/day stopped 5/15 (5 days washout) ✙Prednisone 2.5mgs tab as of 5/19 post op: 2.5mg 2x/day for 7 days Gabapentin 50mg/mL: 60 mg (1.2mL dose) 3x/day ✙Pepcid AC 5mgs 2x/day.]
My thoughts (depending on how he is this morning) are that we need to shade the gabapentin closer to every 8 hours than 12?
Post by Denny & Osito 5 hours prior: Just got him out of his crate. He's in pain but it's not as bad as last night( 10 hours since last gabapentin). Fed, gave gabapentin and pepcid. In 30 minutes I'll give a pred.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on May 19, 2024 8:20:56 GMT -7
Denny, thanks for including all the background information about the meds.
I would give gabapentin PROMPTLY evert 8 hrs. Gabapentin lasts for 8 hours in the body.
MAKE SURE Osito's PAIN IS fully in control day and night. Pain free right up to the next dose of gabapentin: 1) James S. Gaynor, DVM, MS, DACVAA, DAAPM Veterinary Anesthesiologist, Peak Performance Veterinary Group, Colorado Springs, Colorado: Good pain control has a number of significant physiologic benefits. Pain elicits a stress response that’s important for survival, but it’s detrimental when severe or prolonged.... breaks in analgesia lead not only to an uncomfortable patient but also to maladaptive pain that serves no purpose, which makes it more and more difficult to keep the dog comfortable.
2) The veterinarians at Best Friends Veterinary Center give a good explanation about complicated topic on pain:
· It is easier to prevent pain than to get it under control once it is there. It also takes higher dosages to bring pain back down once it is present. The best pain management preempts the pain, cutting it off before it has a chance to start. This is why we usually have you start your pet’s pain medication prior to surgery, and why we use high doses of medication immediately following a painful injury or procedure and then taper down gradually. · Pet owners get worried when their pet is groggy and “drugged up” but that’s normal when a dog or cat is on strong pain medication, just as it is for a human on morphine. Animals can’t push the button on the morphine pump so we have to guess at how much medication they need. It is always better to have a groggy pet who is comfortable than one who is painful. Pain reinforces itself. The more pain transmitters are used up the harder the body works to replace them and the more become available to trigger yet more pain. With severe pain, even gentle touches can trigger pain because the whole nervous system has been over-sensitized. This is called “ramp up.”
STOMACH PROTECTION When on ANY anti-inflammatory drug (Rimadyl or prednisone) the GI tract should be protected for the duration of its use.
Let us know if you are dosing Pepcid AC 5mgs twice a day (every 12 hours. Pepcid AC lasts for an effective 12 hrs.
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Post by Denny & Osito on May 19, 2024 9:43:53 GMT -7
Confirming we are giving a quarter pill (5mg) of pepcid [?x/day]
30 minutes before the prednisone.
20 minutes from next 8 hour interval and it was almost perfect. Problem is he goes absolutely nuts when we come back from anywhere and the barking tweaks his neck.
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PaulaM
Moderator. ![*](//storage.proboards.com/forum/images/stars/star_magenta.png) ![*](//storage.proboards.com/forum/images/stars/star_magenta.png)
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,793
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Post by PaulaM on May 19, 2024 10:34:44 GMT -7
Confirm: Pepcid AC (famotidine) 5mgs ?x/day (should be 2x/day--every 12 hrs)
Call and explain his behavior. Ask for a traZODone or other drug to help him be able to relax in his suite.
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Post by Denny & Osito on May 19, 2024 14:21:34 GMT -7
SO glad this board was available on the weekend (Osito's surgeon not available on weekends).
Pumped up meds schedule seems to be working well.
In hindsight,I should have STARTED with every 8 hours and maybe backed out to 12 over time.
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PaulaM
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Posts: 19,793
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Post by PaulaM on May 19, 2024 14:36:37 GMT -7
Denny, while the surgeon may not be on duty over the weekend, there are vets there who can access Osito's file and adjust meds.
Confirm: Pepcid AC (famotidine) 5mgs ?x/day (should be 2x/day--every 12 hrs)
Assume a BIG surgery will be a painful thing. Don't think about scrimping on pain meds. The pain due to the operation itself usually finally goes away in about 12 days. Make sure Osito is not deprived in mgs nor x/day doses.... Pain meds last for 8 hrs.
We are a group who LOVE the detail. So your saying "pumped up" means you give: Gabapentin 1.2mL dose promptly every 8 hrs (3x/day) ?
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Post by Denny & Osito on May 20, 2024 3:03:43 GMT -7
So yesterday/this morning went absolutely perfectly.
No pain indications and all meds delivered a the right intervals. Using the chart Dodgers List provided to track meds.
[posted May 19:] Confirming:
Now doing Gabapentin every 8 hours religiously
Pepcid given 30 minutes before his prednisone (2x a day 12 hours apart on both meds)
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PaulaM
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Post by PaulaM on May 20, 2024 9:20:42 GMT -7
Denny, your report warms my heart and makes my day. I am so happy for Osito. Good job pet parents... you got things under control for Osito.
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Post by Denny & Osito on May 20, 2024 15:18:24 GMT -7
I've got the same question in to the neuro (yet to hear back) but I'm wondering are there any time limits to how long we can keep giving gabapentin at this rate? I understand we have to absolutely crush the pain,but what would time/procedure likely be for reduction?
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PaulaM
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Posts: 19,793
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Post by PaulaM on May 20, 2024 15:51:29 GMT -7
Denny, it takes all of the surgery caused swelling about 14 days to resolve. It is VERY typical to give 2-3 pain meds promptly every 8 hrs to make sure the dog suffers with no pain for about 2 weeks.
Osito, you are telling us is pain free with only one pain med (gabapentin) given promptly every 8 hrs. That is wonderful!
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Post by Denny & Osito on May 27, 2024 7:49:51 GMT -7
5/27: OK,thanks to this board Osito seems to be recovering nicely. Pain is being managed and all meds are being given until I get a taper schedule (that will likely be tomorrow). I was hpoing I could get the board's opinion about an activity schedule post the two week restrictions. I got the impression the surgeon is going to be pretty liberal with activity and I'd like to be a little more conservative.
5/22 Quick update. We have stuck with the current med scheduling. Osito seems to be showing steady improvement. Pain is in check and wound is healing nicely.
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PaulaM
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Post by PaulaM on May 27, 2024 8:04:22 GMT -7
Denny, most surgeons want either 4 or 6 weeks worth of post-op rest to heal all the surgical areas. This post-op rest includes the surgeon's directed at home PT.
Once the directed post-op rest has been complete, then a dog can safely start a gradual reintroduction back to family life and PT.
We wait to hear from you the number of weeks the surgeon has directed for post-op rest.
Once we know Osito's graduation date, then we will ask for updates on his current neuro situation. -- the current neuro issues: wobbly legs, knuckling under paw?, can't move up into a stand by himself, etc.
Your answers is our base to reply on specific things you can do for that safe, gradual transition back to his home life and ideas for getting PT, if needed, at a clinic or things you can do at home.
Let us know how many weeks Osito has been directed for post-op rest so we, too, can mark our calendar for Osito's graduation day.
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Post by Denny & Osito on May 28, 2024 12:43:48 GMT -7
OK,I spoke to the surgeon's office today. The points I got were:
Start 1 tablet ▼prednisone (1/2 of current dosage) tomorrow for one week.
Sutures removed 5/30 (two weeks)
After sutures;discontinue ➖gabapentin
[Moderator's note: please do not modify 13.4 lbs 6y.o. Rimadyl as of 5/14: 25mg 2x/day stopped 5/15 (5 days washout) Prednisone 2.5mgs tab as of 5/19 post op: 2.5mg 2x/day for 7 days as of 5/29: 1.25mgs ?x/day for 7 days Pepcid AC 5mgs 2x/day.]
The only graduation news I've gotten is a "gradual return to normal activity." I'm not really happy with that and I'm going to push for a more detailed activity schedule.
Osito's only deficits seem to be a slight weakening of right rear leg. You can only see this when he tries to urinate by kicking up his left leg while bracing on his right. He sometimes has a little stumble.but is always able to correct.
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Post by Romy & Frankie on May 28, 2024 14:01:57 GMT -7
I hope you can get a more detailed schedule for Otis' return to activity. It always should be slow and steady to help build up muscle strength, but too much activity to early can prolong healing of the surgical site.
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Post by Denny & Osito on May 28, 2024 15:41:43 GMT -7
OK their response is:
2 weeks of strict rest
Followed by 2 weeks of 50% activity (I'm not sure how to interpret this)
Normal activity. This would make his graduation 6/14-15? I think this schedule is too ambitious.
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PaulaM
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Posts: 19,793
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Post by PaulaM on May 28, 2024 18:22:37 GMT -7
Denny, if you are saying your surgeon directed 14 days of strict post-op rest, then Thursday 5/30 would be the graduation date. This is the comment we would start to make knowing that Osito has currently only a small degree of weakness in his right rear leg. Let us know if we should hold off to a different graduation date or continue on....GRADUATION, A SLOW RE-INTRODUCTION Determine how you are going to ease back into more normal activity at graduation from rest. The idea is to gradually give more freedom under controlled conditions. Not free rein of the house nor yard immediately! LOL Osito's muscles are soft and out of shape after the rest period. Take a look at our information. Gradually building your dogs muscles over a month's time will have your dog safely running and having fun again! SAMPLE SCHEDULE Here is a sample schedule to safely and slowly introduce your dog back to family life and physical activity: dodgerslist.com/back-friendly/DIY back PROTECTION around the house ![](https://i2.wp.com/dodgerslist.com/wp-content/uploads/2020/07/home-back-protect-banner_700-45kb.jpg) 1) Good ideas in making your home back friendly: dodgerslist.com/home-protect-ivdd-backs/2) In case Osito would find he doesn't have good leg control on slick floors.... here are ideas and products to provide improved traction: dodgerslist.com/traction-solution-improvements/3) Teach him to be safe and not jumping up or down, but to use a ramp whether over steps leading outdoors or to furniture in the house.
Dogs are best at visual learning rather than verbal commands. Dog trainer Anna Jane Grossman says “Dogs learn in pictures. Inside your dog’s brain is a very simple algorithm – pleasant images in one place and unpleasant images in another." If your Osito is one to take shortcut off a ramp.... here's how to train for that:
and more ideas we can offer........ when you know the graduation date.
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Post by Denny & Osito on May 29, 2024 8:17:48 GMT -7
Well if graduation is at end of the strict rest than 5/30 is his graduation date. Thursday, May 30
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PaulaM
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Posts: 19,793
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Post by PaulaM on May 29, 2024 9:40:38 GMT -7
Denny, it would not hurt to reconfirm if our slow and gradual things are in line with your surgeon's for Osito. IF so, and 2 weeks of rest is what he directs, this is my caution to ensure no rowdy, energetic movements for Osito and is always supervised. Always in your control via a leash attached to the harness. From now on collars are just to hold his tags. If you cut your finger, can you remember how long it took to form a nice secure scar tissue where you could start doing vigorous movement? During the finger cut healing time you could move your finger a small degree, gently, without damaging the scar tissue formation. But move it too much and finger would bleed. Meaning it had to start all over again in healing. Osito needs all of the parts of his body accessed during the surgery to heal and form good scar tissue. Also, even though prednisone is now on the taper, it IS still in his system. It may make him feel good as new. And thus make him eager to overdo things. So be very cautious of not allowing Osito to jump up or down, dart of running maddly after something. That is too much movement for the surgical areas. Look for activity that is slow and gently. So with all of that in mind, pat yourself on the back for the wonderful care you have been giving Osito! HAPPY DAYS AHEAD 1) You and your dog have survived a disc herniation! Learn what you can do from this point forward in a quick illustrated summary. Especially good to use with youngsters who may be around Osito to help them understand Osito's disease: dodgerslist.com/wp-content/uploads/2024/04/ivdd-6-Life-with-IVDD-Dodgerslist.pdf2) Now for the nitty gritty of living with an IVDD dog. How to handle dentals, nail trims, safe ways to have fun together, and more on this page. dodgerslist.com/after-graduation-living-with-ivdd/ PT THERAPY AT CLINIC or HOME The way you describe Osito's pretty good leg ability with some slight weakness stability, doubt he needs anything from a clinic. However, if you believe he could use extra help or means of safe exercise... it would be getting underwater treadmill for him. dodgerslist.com/surgery-dog-water-therapy/NOTE: You can also use those same water treadmill principles of water height at home in a $15 child's inflatable pool as described in the underwater treadmill video here: Water 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. Muscle re-education and strength to perfect the art of walking a normal gait.
-- Strengthening core muscles at home. This applies not just for humans, but REALLY applies to the IVDD dog: Core exercises don't require specialized equipment. These are 4 exercises you can do at home: 1) Sit to Stand, 2) Down to Stand, 3) Three Leg Stand, 4) Backing UP. The last exercise presented in the video, ⚠️ HIP extension, is NOT for dogs with IVDD back disease! May we turn the tables and ask YOU for help? Did you know there are less than a handful who volunteer daily to help dogs and their owners? We need helping hands from other Forum members in educating. Education about disc disease is our number one mission! We invite you to hop on to our educational bandwagon team. Too many dogs are put to sleep because owners lack education about IVDD treatment. STRICT crate rest and proper medication have helped many dogs recover. We depend on all members to pay it forward for the help they have received with their dog by helping us educate!
Pick what suits you....
We depend on you. Here are some ways to help..
-- When in conversation at the grocery store line or wherever you may meet breeds most prone to IVDD (Dachshunds, Beagles, Poodles, Spaniels, Shih Tzus, Pekingese, and Chihuahuas, Frenchies) give out our free little wallet cards. Hand carry our literature and print out our letter of introduction for your vet. for your vet and wallet cards for you Introduce us to your surgeon for the benefit of his next patient. Read what surgeons and other vet professionals say about Dodgerslist:
-- Would you consider helping another trying to make decisions about surgery? We have a directory where you can share surgical info. State: Hospital: Address: Cost: Date of surgery: What was included in cost (MRI?, days stay, ER? PT? meds for home, sling, etc.) Comments:
And finally, PLEASE don't be a stranger! Stop in periodically. We really do love to hear how your dog is doing. We'd love a short video clip to see Osito in action at home, at PT and living & loving life in spite of IVDD! If you see a new Forum member in a tough spot, give them hope. A brief paragraph about your dog can be insanely supportive and inspiring in a time of need!
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Post by Denny & Osito on May 30, 2024 4:48:36 GMT -7
Thanks Paula! I think we are going to take things slow for a month (mid June) before gradually ramping things up. We've been using a pet stroller and it's been a godsend in terms of mobility and keeping him around people while resting. We'll continue to use it. We'll also be using it from now on. It's going to be Osito's default position when the wife and I are eating. He had a bad habit of jumping in her lap while we ate-no more. Sutures come out today.
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PaulaM
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Posts: 19,793
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Post by PaulaM on May 30, 2024 11:21:38 GMT -7
Let us know the vet comments with your suture removal appt. today.
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