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Post by John & Thalia on May 28, 2024 10:12:33 GMT -7
[Original subject line: Conservative or Surgery?]
[NOTE this post has now been marked for important info. If there is additional information, please make a new post. We don't want to miss any new information you provide. Thanks for understanding.-
[MED LIST/HISTORY- Moderator's Note. Please do not edit weight? 10.y.o 5/25 r. frnt paw drags, falls name of anti-inflammatory as of 5/25: ?mg ?x/day name of all pain meds ?mg ?x/day name of stomach protector Pepcid AC for the duration of anti-inflammatory ]
Hello, my 10 year old Doberman has been diagnosed with “neurologic examination localized a problem to her neck. An MRI revealed a disc herniation at the level of C5 - 6 disc space.” She is ambulatory, but has regressed the past 3 weeks from slightly dragging her front right paw to stumbling and falling sometimes. She has not showed any outward signs of consistent pain. She has been diagnosed by a neurologist. We have a tentative surgery date set, and she has been on strict crate rest for 3 days now. My question is I should go surgical route or conservative route, is her age a major factor in recovery of the surgery? I want what’s best for her, what are your thoughts? thank you.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on May 28, 2024 11:44:53 GMT -7
Welcome! Please let me know if you are John and your girl is Thalia. We do want to get your names correctly. I'm Paula, and very glad you have joined us all here. I will be watching for your introduction of your girl with answers to our questions. Until then I can offer the same general information that you likely can find elsewhere on the internet. Hoping this information goes towards you being able to come to a surgery or non-surgery treatment, have a good question and answer talk with your surgeon in deciding which treatment. #1 is of course doing the 100% STRICT rest to prevent the neck disc from further damaging the spinal cord beyond dragging the right front leg. With a large breed dog, it may be unsafe for your own back to lift and carry her. And it may be unsafe as in you can safely keep her back supported under both ends of her body and keep the back parallel to the ground. Check out these large breed care tips to use at potty time and more: 🚩 dodgerslist.com/2022/02/10/large-dog-care-tips-ivdd/ NOTE. It is still important that the amount of movement to the potty place be minimized to a few minimal footsteps to take care of business.--One of several tips explained: try a pee pad right outside and adjacent to the crate. Full scope of how to do non-surgery conservative treatment until or if you decide on a surgery: 🚩 dodgerslist.com/strict-rest-recovery-process/EXTRAs you can do at home for a Neck disc 🚩 dodgerslist.com/cervical-care-tips/HOW TO DECIDE on which treatment: 🚩 dodgerslist.com/surgery-vs-conservative/TOOLS to monitor and understand the full picture of non-surgical treatment ** 1) Help all of your family recognize emergency signs and action to take. 🚩 dodgerslist.com/wp-content/uploads/2023/12/Roadmap-for-Fridge.pdf 2) 🚩 dodgerslist.com/ivdd-healing-the-torn-disc/ the 4 phases of disc healing. 3) Avoid dangerous detours during non-surgical conservative treatment. D/L and tape to your fridge for handy reference. 🚩 dodgerslist.com/wp-content/uploads/2023/12/Roadmap-for-Fridge.pdf
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Post by John & Thalia on May 30, 2024 9:12:33 GMT -7
[IF there is any any additional information, please do so in a new post. We don't want to miss any important information if it were to be added to this post. Thank you for understanding.]☆ 1 pain? Hello! she is currently in pain in her stomach. The actually spine issue never showed any on going pain. There were a few instances over the past few months where she yelped out, then the pain was done. She had an MRI Thursday 5/23.Picked her up the following day 5/24 an we have been dealing with some pretty bad GI distress since then. The GI is the main problem right now.
[MED LIST/HISTORY- Moderator's Note. Please do not edit 61 lbs 10 y.o. 4/29 no crate rest Rx'd by DVM vet,, no Pepcid AC during Previcox, dragging right front paw (neck disc) Previcox as of 4/29: STOPPED 5/23 (to allow a 4-day washout for a pred switch on 5/27) -Prednisone 10 MG as of 5/27: 10mgs 2x/day. ONE DOSE caused explosive vomit/diarrhea. STOPPED 5/27 - Gabapentin 300 MG as of 5/24: 2x/day STOPPED 5/28 - Trazadone 100 MG used once 5/25 - cerenia inj 5/29 by general vet cerenia tabs as of 5/30: 24mgs for 4 days, ends 6/4 Carafate 1gm tab: 1000 mg 3x/day Metronidazole 250mg tab as of 5/29: 375mgs (1½ tabs) 2x/day Endosorb 1.5 gram tab: 3g (2.5tabs) ?x/day - Omerprazole as of 5/24: 20 mg 2x/day STOPPED 5/28 - Famatodine as of 5/24 ?mgs 2x/day STOPPED 5/28] [date?]We have gone to primary vet and have started her on cerenia Metronidazole 1 1/2 250 mdtabs every 12 hours Carafate 3 times daily Endosorb tab mgs?: as of 5/29: ?mg (2.5 tabs) ?x/day actually given?★2 How much does your dog weigh? 53 lbs she was 61lbs the day of the MRI Age?10A.. Please list the exact names of meds currently given, their doses in mg’s and times per day given. She had an MRI Thursday 5/23.Picked her up the following day 5/24 an we have been dealing with some pretty bad GI distress since then. --------- I must add The neuro had her on Prednisone 10 MG on Monday 5/27 then 1 Tab every 12 hours for 5 days after that then 1 tab very 24 hours 7 days then 1 Tab every 48 hours 7 dosesOmerprazole 20 mg capsule twice a day Famatodine twice a day Gabapentin 300 MG every 8-12 hours Trazadone 100 MG 8-12 hours I have stopped all of this until I figure out a different conservative plan Thank you again, sorry I didn't know exactly where to add this info-------- The GI is the main problem right now. [date] We have gone to primary vet and have started her on cerenia Metronidazole 1 1/2 250 mdtabs every 12 hours Carafate 3 times daily Endosorb B.. 🔘 If on a steroid….what was the start date & dose? Date of steroid taper? She has been prescribed Steroids only one dose was given her stomach was not great before first dose, and. worse after. She is improving a bit now 🔘 OR.... date of a NSAID stop? Nsaid were stopped 5/23☆ 3 -- Does you dog show red flag signs of stomach damage? Avoid confusion... list only those you actually observe: Yes loose stool? Yes bleeding ulcers? Red stool ☆ 4 What breed? Doberman Your dog’s name? Thalia Your name? ☆ 5 🔘 There was ventral extradural spinal cord compression at the level of the C5 - 6 disc space. Mild dorsal flattening of the spinal cord at the level of C4-5, C5-6, and C6-7 - consistent with subclinical stenosis ACVIM neurologist ☆ 6 🔘 What was the date you saw the vet for CONSERVATIVE treatment? I have a date set for surgery 6/6/24 But I am not going to go through with it. She isn't used to being away from me or my family, the facility is great, but she needed to be sedated so heavily and she has a history of sensitive stomach, she regressed physically so much from just the one day stay and MRI I would like to try a conservative approach. Super tried and true tips for setting up the recovery suite, the mattress and more! dodgerslist.com/strict-rest-recovery-process/
STRICT means: - no laps - no couches - no baths - no sleeping with you - no dragging or meandering at potty times. - no PT - no chiro therapy Why Chiropractic is not recommended for pain for an IVDD dog: dodgerslist.com/2020/04/22/chiropractic/ (After 5/20/2024: www.dodgerslist.com/chiropractic/ )☆ 7 🔘 bladder control? Yes 🔘 She did have overflowing bladder after her stay at the neurologist, but is good now, she wasn't able to get into position following her stay ☆ 8 wobbly walk? move the legs at all? or wag? Yes she can she's feeling bit down from her GI upset, but I can tell she's getting better.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on May 30, 2024 9:52:31 GMT -7
I'm having difficulty in noting the date of med use. This is important information to understand what is going on. Data from you is what we base our comments on.
Please add a date of start or when stopped to these meds: -name of Nsaid were stopped 5/23
-Prednisone 10 MG as of Monday 5/27: then 1 Tab every 12 hours for 5 days after that then 1 tab very 24 hours 7 days then 1 Tab every 48 hours 7 doses (Actually only one dose was given and then pred was stopped on date?)
- Omerprazole 20 mg 2x/day Date started Date if stopped? - Famatodine twice a day ?mg 2x/day. Date started? date if stopped? - Gabapentin 300 MG every 8-12 hours (which actually dose promptly on time?) - Trazadone 100 MG 8-12 hours (which actually dose promptly on time?) - cerenia ?mg ?x/day Date Started? Date if stopped - Metronidazole 1 1/2 250 mdtabs every 12 hours - Carafate 3 times daily ?mg 3x/day (how many grams in one whole tab?) Start date? Date if stopped? - Endosorb ?mg ?x/day Start date? Date if stopped?
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Post by John & Thalia on May 30, 2024 10:21:44 GMT -7
- Previcox Start 4/29; stopped 5/23 - Prednisone 10 MG as of Monday 5/27: then 1 Tab every 12 hours for 5 days after that then 1 tab very 24 hours 7 days then 1 Tab every 48 hours 7 doses (Actually only one dose was given and then pred was stopped on date?) Yes only one dose on 5/27, she had explosive diarrhea and throwing up constantly after
- Omerprazole 20 mg 2x/day Start 5/24 stop 5/28- Famatodine twice a day ?mg 2x/day. Start 5/24 stop 5/28- Gabapentin 300 MG every 12 hours start 5/24 stopped 5/28- Trazadone 100 MG 8-12 hours (which actually dose promptly on time?) They actually told me to use as needed, I used it once 5/25- cerenia Injected 5/29 at general vet. cerenia: 2 Tablets daily 24 mg for 4 days started 5/30- Metronidazole 1 1/2 250 mdtabs every 12 hours Started 5/29- Carafate 3 times daily ?mg 3x/day started 5/29 doesn't have exact grams on bottle. Pill has N S1 on it [1 gram tabs reference: www.drugs.com/imprints/n-s1-16251.html ]- Endosorb ?mg ?x/day Start 5/29 2 1/2 tabs every 8-12 hours till diarrhea stops ?mgs in one tab? ?x/day actually given?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on May 30, 2024 10:23:20 GMT -7
Thank you, let me organize my thoughts with this current information and then reply
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Post by John & Thalia on May 30, 2024 10:36:25 GMT -7
You're welcome, I appreciate your thoughts
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on May 30, 2024 11:11:30 GMT -7
John, let us know if you stopped the meds personally or if the vet is the one who has Thalia on these current meds? We always like to know the credentials of the person changing meds, given a treatment etc. Any any event..these meds seem appropriate as long as Thalia is not showing any signs of pain from a disc episode nor new/increased neuro diminshment from the suspect neck disc. Typically a neck disc is a very painful thing requiring usually 3 different pain meds to get pain in control. Thalia is no longer on any pain med. Thalia's current med list, please review for correctness: cerenia inj 5/29 by general vet cerenia tabs as of 5/30: 24mgs for 4 days, ends 6/4Carafate 1gm tab: 1000 mg 3x/dayMetronidazole antibotic 250mg tab as of 5/29: 375mgs (1½ tabs) 2x/dayEndosorb 1.5 gram tab: 3g (2.5 tabs) ?x/day Trazadone 100 MG used once 5/25
Generally, the GI protectors are used for the duration of any anti-inflammatory drugs because they cause extra acid production. There are other factors that also cause extra stomach acid: STRESS! Thalia's whole world has changed. She requires strict rest inside of a recovery suite that limits her movement. Her GI gut is very stressed as evidenced by blood in her red stool. The lower digestive tube lining has been breached with red blood another stress on the body. Discuss with a vet you trust, if adding back in Famotdine (it works in 30 mins) to reduce stomach acids. Make sure you are effectively using the Carafate (sucralfate):Sucralfate. Sucralfate not only “bandages” the ulcer but accumulates healing tissue factors in its bandage; it not only protects the ulcer but actively assists in the healing procss. In order to be most effective, this med should be given: 1. 30 minutes prior to Pepcid AC, if your vet concurs it should be brought back in use. 2. Give Carafate on an empty stomach at least one hour before feeding. Read up on all meds your dog is on. Here is the link to carafate (sucralfate) marvistavet.com/sucralfate.pmlI recommend a med chart if you are not yet using one: 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/2023/12/med-chart-printable.pdf So below is a possible dosing schedule for first dose of the day. Again you can "inch" up or back an hour a day til you achieve a schedule that works for you. 5:00am sucralfate 6:30am Pepcid AC (how many mgs had been Rx'd for Thalia)? 7:00am 7:00am breakfast ** i.postimg.cc/6QLMK2Jp/Med-Chart-PREVIEW.jpg
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Post by John & Thalia on May 30, 2024 11:28:46 GMT -7
The vet has stopped the other meds until we get her GI under control. Seeing that she has never shown any outward signs of pain, does she actually need pain meds? Or do we give them preemptively? Does the 8 week crate rest rely upon steroids to work? I only ask these questions because of her sensitive stomach Thank you again for all the info
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on May 30, 2024 16:14:04 GMT -7
John, during conservative treatment there are 4 phases of healing. Each take different things and have a different length of time to heal. More on how to monitor and be aware of each phase later on. Some history and information seems to be missing for these chain of events. Can you fill us in? 4/29 drags front right paw; Previcox Rx'd via local DVM for 25 days -- Had Previcox ever been stopped at say a 7-day course or a 14-day to prove if it was even still needed for painful inflammation? -- 4/29 was Thalia under STRICT rest in a recovery suite?5/23: MRI and diagnosis -- 5/24: What was the reason for Neuro's Rx of Gabapentin?
5/23: Previcox stopped for 4-day washout to switch to Prednisone -- 5/27: What was the reason switch to Prednisone by the Neuro surgeon?5/27: Non emergency surgery booked for 6/6, but since declined 5/28: Gabapentin stopped5/29: No report on Forum of any pain with 5/28 stop of gabapentin and 5/27 stop of prednisone.5/29: Reported on Forum increase of neuro damage of now stumbling with the stop of one dose of pred and no other inflammatory on board. HOW to MONITOR Neuro declineAs damage to the spinal cord increases, there can be a predictable stepwise deterioration of functions if excessive back/neck movement for example. Nerves do heal in the exact opposite order nerve damage occured. 1. 4/29 Pain with initial tear of disc and ensuing swelling 2. 4/29 Wobbly walking legs cross 3. 4/29 Nails/toes scuffing floor 4. ___Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all 5. ___Weak/little leg movement, ___ 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 9. ___Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.
MONITOR FOR NECK PAIN SIGNS⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned back ⚙︎ restless, can't find a comfortable position ⚙︎ slow or reluctant to move in suite such as shift positions ⚙︎ not their normal perky interested in life selves ➕ these signs specific for a neck disc: ◻︎ head held high/ nose to the ground ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg up flamingo style not wanting to bear weight WHAT DOES RECENT NEURO DECLINE MEAN?The 5/29 stop of Prednisone coincides with your 5/29 report on the Forum of increased neuro diminishment of front right leg weakness now stumbling. John, no vet knows how long a course to use for any anti-inflammatory drug. It is prudent for them to guess at a 7-day or maybe 14-day course. Then assess for pain/new neuro diminishment. Rule of thumb and the end of an anti-inflammatory course:
pain or neuro diminishement = swelling= another course of anti-inflammatory drug+ all pain meds, Pepcid AC back on board.
Using dates you supplied, in essence when the Neuro stopped Previcox 5/23 and only one prednisone dose on 5/27, gabapentin had been stopped on 5/28, that was kinda of the test! It seems the test indicated there was still spinal cord swelling that caused a surfacing of increased neuro diminishment of now 5/29 stumbling. You and your local DVM vet will have to decided if warranted to double protect the GI tract (both carafate PLUS famotidine) and try an anti-inflammatory again at some point to make sure all spinal cord swelling has been resolved. Monitor neuro functions and alert your vet if there is any new or increased loss of function. Hours do matter would neuro functions decline to get an anti-inflammatory on board.
Make sure you are not seeing any signs of pain especially those noted to be specific for neck discs. IF pain, then pain meds would need to be on board. Recommend you print out the non-surgical CONSERVATIVE Roadmap. The more you know, the better you can discuss things with a vet and advocate for Thalia. Here is the PDF to download and print for your fridge: dodgerslist.com/wp-content/uploads/2023/12/Roadmap-for-Fridge.pdf
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Post by John & Thalia on May 30, 2024 17:59:05 GMT -7
Deleted lengthy quoted text in preference of only the members words in a post.
[UPdated for accuracy MED LIST/HISTORY- Moderator's Note. Please do not edit 61 lbs 10 y.o. 4/29 no crate rest Rx'd by DVM vet, dragging right front paw (neck disc) 5/31 less knuckling
-Previcox as of 4/29 used without Pepcid AC/ without test stop for 25 days √5/20-21 knuckling: STOPPED 5/23 (to allow a 4-day washout for a pred switch on 5/27) -Prednisone 10 MG as of 5/27: 10mgs 2x/day. ONE DOSE caused explosive vomit/diarrhea. STOPPED 5/27 - Gabapentin 300 MG as of 5/24: 2x/day STOPPED 5/28 - Trazadone 100 MG used once 5/25 - cerenia inj 5/29 by general vet Cerenia tabs as of 5/30: 24mgs for 4 days, ends 6/4 Carafate 1gm tab: 1000 mg 3x/day Metronidazole 250mg tab as of 5/29: 375mgs (1½ tabs) 2x/day Endosorb 1.5 gram tab: 3g (2.5tabs) ?x/day - Omerprazole as of 5/24: 20 mg 2x/day STOPPED 5/28 - Famatodine as of 5/24 ?mgs 2x/day STOPPED 5/28]
[re: stops of Previcox.]No it was never stopped, I was using it until Neuro could see me. [re: strict rest since 4/29] No, only thing stopped was walks as I was instructed
[re: Neuro 5/24 gabapentin rx] Neuro thinks that even tho Thalia doesn't show pain, that she might just be tough.
[re: reason for switch to pred] Reason was to try and get her into a stronger spot before surgery
I wrote that incorrectly, she was only dragging her front right paw initially,
on 5/21 she started to decline, to stumbling, I called Neuro and they were able to get me in sooner for MRI. The stop of prednisone didn't have any effect
She is doing a lot better [re: stumbling?] today [5/31] even from just a bit of strict crate rest, when I take her out her she has way more control during pee and pooping.
Than you again for your guidance
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on May 31, 2024 10:46:40 GMT -7
John, here is a handy tip for you which also helps us out. When replying use the writing space at the bottom of the page called " QUICK REPLY" This area allows you to type there. Allows you to scroll back up to the post you are replying to and then back down to continue writing. We try to put all of our questions in PINK to make them easy find/respond to.No need to quote us in your post. Just use 1-3 words of reference for each answer. Before we post, we re-read your old posts to refresh our memory. So we are only looking to read your words, not ours. Dr. Nancy Kay, DVM, ACVIM has hit it on the nail especially with our disease of IVDD. Each of us needs to be self educated so we can team up to work with our vets. Our hope is in the next few days as your mind calms down and Thalia is in a good place, you will begin to have a chance to delve into the readings on our Main Webpage www.dodgersLIST.com and be the prepared IVDD savvy owner your Thalia needs as a good team captain with good advocate skills. And to discern who is to be hired for her IVDD health care team. 1) This is a good spot to start. Get the over all picture of what IVDD is and how to live many good years ahead with your IVDD Thalia. Takes about 10 minutes for "Shortcut Thru IVDD" dodgerslist.com/time-and-ivdd/2) Then while you are on the www.dodgersLIST.com website, do click on the rest of the "KNOWLEDGE" pull down menu items. SUMMARY of what happened to Thalia with your updating of events. 4/29 drags r. frnt paw drags. DVM vet Rx's 25 days of Previcox. No crate rest Rx'd. Was Pepcid AC, a stomach protector Rx'd 4/29 for the duration of Previcox? TAKE AWAY: non-surgical conservative treatment = STRICT limited movement rest to allow the disc to heal. PLUS anti-inflammatory to get the painful spinal cord resolved over 7-30 days. PLUS pain meds to provide comfort as the anti-inflammatory does its work.5/21 On Previcox, w/no crate rest of 8 weeks to heal the disc, neuro diminishment worsens to stumbling. TAKE AWAY: lack of STRICT limited movement may have caused a disruption to the healing neck disc scar tissue. Which in turn caused more pressure to the spinal cord. A need to restart crate rest from square one on 5/25. Most surgeon's would not choose the risk of a surgery for a walking dog. Did the surgeon have the full history, sequence of events/dates to take into account in his decision making with Thalia's recent neuro diminishment of stumbling?5/23 Neuro appt Previcox is stopped w/ a tentative 6/6 surgery date. Stomach protection Rx'd: Omperazole + Famotidine. Can you be specific about what you observed with these general phrases "doing better" "way more control"? at potty time what did you observe about her right front leg/paw? -- right front paw places properly on the ground? --right front paw if knuckled under could right itself or not at all? -- right front paw drags? How is her GI issues coming along now with: metronidzole, carafate, endosorb on board? Specific details please: loose stool, red in stool, black in stool, well formed stool. Any signs of pain? tends to hold her head high or nose to ground; looks up with just eyes and does not move head and neck easily; holds right front leg up like a flamingo bird because it hurts to bear weight on; yelps; shivers
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Post by John & Thalia on May 31, 2024 16:45:41 GMT -7
Pepcid was not a stomach protector during the Previcox use
Starting around 5/20 whenever she would squat to pee her front right paw would knuckle and she would be quite unbalanced.
Right now, she isn’t 100% but there seems to be less knuckling when urinating.
Gi is doing a lot better, her appetite is back. No signs of pain
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Post by Romy & Frankie on Jun 1, 2024 13:08:28 GMT -7
I am happy to hear that Thalia now has an appetite, no signs of pain and neuro deficits decreasing.
Is surgery still being considered for June 6?
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Post by John & Thalia on Jun 2, 2024 12:51:05 GMT -7
Thank you
No I have taken surgery off the board. The neurologists have given me prednisone regimen once her stomach is stable.
Funny thing is that Thalia goes to work every day normally, I own a dog grooming shop, she is super calm and I have customers always commenting that they wish their dogs were as calm as her. I had never left Thalia with anyone other than a family member, they had to sedate her pretty heavily plus the anesthesia really did a number on her. The vomiting and diarrhea they believe is stress induced colitis. I’m not putting her through that again. I’ll do everything else I can for her tho.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,884
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Post by PaulaM on Jun 2, 2024 13:16:52 GMT -7
John, just confirming as I did not understand your comment.... so there is no change it your declining of a surgery since you wrote on May 30 "I have a date set for surgery 6/6/24. But I am not going to go through with it. "
That is good Thalia is able to go to your shop and stays super calm!!!
Also less knuckling is a good thing showing there is nerve repair already going on. This is a very good direction of healing. Stick to strict limited movement of the back/neck spine to prevent any setback of the healing disc. Mark your calendar for a July 20 graduation day!
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Post by John & Thalia on Jun 2, 2024 16:19:15 GMT -7
Hello Paula! No there is no change, we will not be going through with surgery. I have it marked! We can’t wait
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