For more information: https://hpets.org/index.php?option=com_ ... icle&id=71
Yeah, I don't know the answer for sure either. I know I would feel encouraged because she does have deep pain sensation in both hind feet. That means the signals are getting through, and that's what you want to see.
I did not realize you were in the medical field, that is great! So on a dog, upper motor neuron would be T3-L3 and lower motor neuron would be L4-S3. Looking back at your post, I think you said her surgery was at L4, so she's LMN like you said and that would tend to be a dog that does not have tight sphincters. Do you think she could just be holding it? She's been told her whole life not to go in the house...
On her bowel program, I am not a vet but personally I would not worry about putting on a glove and lubing a finger and inserting it with a dog this size. If you think about it, the stools she leaves in the yard are a bigger diameter than your finger.
You said you tried all the bowel expression tricks, which I suppose might mean a q-tip or an ice cube. But have you tried the squeezing method? It's pretty much foolproof because it does not depend on triggering an evacuation reflex. You simply (gloves or no gloves) feel around your dog's anus and spread your index finger and thumb 2"-3" apart on a dog this size, press in gently on the soft tissue surrounding her anus, and if there is solid waste inside her rectum you will feel it right through the skin. At this point your instinct and sense of touch will probably guide you from there. If you grasp the soft tissue with the stool and squeeze gently, the anus will open and you will be able to pop the leading end out. It does not matter if she is UMN or LMN, it works with either condition. Normally if she has more stool in her colon, it will move forward toward the exit and you will be able to repeat as needed till you have her pretty empty. It is possible once you get that first stool moving, she may be able to push more out herself. Possibly she can push, but relaxing the sphincter initially is what she needs help with. I would have plenty of kleenex next to you. If you cover it with kleenex as soon as she produces it, it does wonders to reduce the smell, and maybe she will feel better about it. Maybe even run a fan when expressing...whatever you think.
If you feel her stools are too solid, you might ask the vet about a stool softener like lactulose syrup. You will probably still have to do the squeeze procedure, but softer stools may make it easier for her.
If you feel she is really backed up and stool softeners are not doing the trick, you might ask the vet about a short course of cisapride. I believe they quit using it with humans (Propulsid) in the US (not sure where you are) but it is still available for veterinary use.
Bowel perforation may be a problem with humans, or perhaps especially the elderly (?), I don't know (?), but that is one problem that has never been reported here as far as I am aware.
I do understand the things you are talking about surrounding the situation. I did not realize you were on the 3rd floor. That helps explain the catheter. And if you are working 13-hr days, that also explains the catheter. Without it you would need to express her bladder every 8 hrs. If she is L4 it is probably something you could do, but you'd have to come home to do it. And I do understand about the expense. It puts you in such a bind when you would gladly pay, perhaps even go into debt, if you were sure of the outcome, and yet they can't tell you. I absolutely do not want to encourage anyone to keep going or spend more and more if there is no hope. She has deep pain so there is hope, but with your schedule and her size and even your housing situation, there are many factors.
Yes, acupuncture is a legitimate treatment. My impression from reading the experiences of people here is, you will know if it is helping after only one or two sessions. If you see no change I would not keep going beyond 2 sessions. If you have a vet trained in acupuncture, you might ask what s/he thinks about number of sessions, I am only going by anecdotal information.
http://www.dodgerslist.com/literature/h ... ncture.htm
As for the replies you're getting, I'm just glad that at least some vets aren't doing the gloom and doom speeches as often as they used to!
I don't suppose there's any way to be sure with the catheter in, but she has deep pain in both hind feet, anal tone, and some voluntary tail movement. It is possible she may have bladder control. It wouldn't be that surprising if she did. I may be wondering too soon, but I've been wondering about that a little bit.
That being said, if she did have bladder control, you don't know how many hours she can go between potty breaks. Larger dogs are more susceptible to pressure sores due to weight, but wetness is an even bigger issue. The quickest way to start a "so-called" pressure sore is to lie on a wet bed, which can cause a urine burn on a pressure point, and then it starts a sore, whereas the dog might have been fine with the weight alone on dry bedding and decent padding. The catheter has kept her dry, and with your background I'm sure you've addressed padding, wrinkles in the bedding, etc.
There is special bedding for wicking away moisture and providing plenty of loft for good padding. Here is one that is frequently recommended. If you have access to human products, those may work, too. It just has to be something where the dog is not lying on wetness. For example, most disposable incontinent pads (underpads, chucks) will only keep the bed dry, they will not keep the dog dry. A dog lying on a wet underpad is a wet dog. That's why something like Palace fleece bedding (or maybe whelping pads) is better. The theory is moisture passes through, and the fabric in contact with the dog stays dry. I'm not sure how good this brand is, but here is an example of whelping pads and a liner that goes underneath. Palace fleece would be my first choice.
The second time (2 weeks later) I noticed her whining on the camera, came home early from work and the cath was out and deflated. She always has an Econe on, but has been kind of pulling herself slowly to different angles on the dog bed, so it may have slipped out? The cath bag was dry, so it could have been 5 hours without peeing for her. Before I took her to the vet to replace that second time, I tried to express her but I couldn’t. But an hour and half later when the vet finally saw her he said her bladder was moderately full, but didn’t try to express her. So yes I think she may have some bladder control. Her bed has never been wet, thankfully. I check it constantly just in case. The past 4 days I’ve been doing a combo of “pureformance” freeze-dried mix that I add water to, and her regular dry food. Her stools has been slightly softer and easier to extract. And she LOVES the food.
I have an eggshell bed that I cover with a trash bag, and put a very soft blanket on top, and surround the edges with pillows. I’ve been checking for sores, none so far.
We are 6.5 weeks post op now, she’s able to bear weight unassisted for up to a minute without wobbly, no walking (I’m happy with the progress).
Range of motion exercises...she continues to refuse to allow them. Will not bend her back legs. Gets very distressed and pulls her upper body away or paws at me if I try even very gently. Has anyone had this problem? Her leg is 18 inches long, big dog. Even when I take her out to stand, I try to put a little pressure on her hind to get a bend and I can’t get it. Worried about contractures...stiff joints.
That's really-really good about the standing, woohoo!!!viewtopic.php?f=4&t=18783&p=96949#p96952
by mud99 » Sun Feb 22, 2015 11:34 am
The stiffness lasted quite a while. When they don't know where their limbs are, they will stiffen them and hold them like that constantly. On top of that, they get cramps and general weakness from being on crate rest, so it's an uphill battle getting them walking again. I would definitely recommend the myofascial release for stiffness - ask about it in PT.
by MarleysDad Sat Apr 04, 2009 10:19 pm
The PT person was even having Marley do weight bearing excercises I think the 4th day post surgery. She also did and is having me do excercises with him on a small pilates ball - resting his chest on the ball and rolling him back slowly while getting his rear legs to bend in all the right and normal places. He has a tendancy to hold his legs very straight and stiff otherwise.
2 complete posts by Jacko's Mumviewtopic.php?f=4&t=12036&p=62247#p62247
by Aus Dilecce Thu Sep 11, 2008 9:28 pm
We did a fair bit of hydrotherapy with her. Bought her a little life jacket and swam her in the bath.
Her little legs used to be so stiff that when we would start cycling they wouldn't bend and we used to do the can can and try to make it fun for her.
by KimK Wed May 07, 2008 11:42 pm
Since she ended her crate rest the 26th of March, there has been "small steps" of improvement each week....literally! She goes weekly to a wonderful hydrotherapist, who is slowly and steadily getting Haley to loosen up her back legs. She was soooo contracted and stiff, now the left leg can bend at the knee with a minimum of massage and heat, but the right leg still is quite stiff and sore for my poor girl. But she is walking!
There are probably more...hope this helps.viewtopic.php?f=4&t=11080&p=56003#p56003
by KimK Tue Apr 01, 2008 6:10 pm
At first, her back legs didn't move at all, but after some gentle massage and the warm water....Haley was moving both legs! Just at the hip flexor, but still....I was thrilled. She started voluntarily moving the paw on her left on Saturday, that was a first also. And now, if I tickle her hair between her paw, she'll draw the foot up very slightly. She still is very stiff legged, the knee isn't bending at all. But the therapist thought that with time, warm soaks and gentle massage....it should loosen up
We will get the urinary cath removed July 11, and then she can start hydrotherapy
She did well weaning off gabapentin, she definitely seems more energized this week.
Another question....her left leg was the first to show motor control, small movements when we “walk” her. The right has shown some signs of toe stretches. This past week or 2 when we position her to stand, she leans very heavily to the right, putting a lot of weight on the right leg. If we leave her more close to a minute her body twists with the right lean and then her legs cross. I’m wondering why she’s favoring her left, like protecting it. Particularly because I thought the left had shown the most improvement so far.
I don't know on the leaning either. I wonder if possibly she might still need a light pain med. If I'd had back surgery 6 weeks ago I'm sure I absolutely would. Perhaps the gabapentin was addressing some residual pain that is now showing? You could be right about the left being better neurologically, but I suppose there could also be some post-surgical pain more on that side. If the therapist checked up and down her leg and hip and didn't find anything, that would be my layman's guess.
My dog's physical therapist says it is not unusual for one leg to come back before the other, or for one to be stronger. Oddly, it can switch unexpectedly and the weak one can suddenly become the strong one for no known reason. So they can switch back and forth like that. They don't know why, but it happens. I just want to say what a relief it is to know she stood up on her own, because surely she had to bend her legs to do that, and she had seemed unwilling to bend them, so that's great! I am so glad for the good news!!!!!
I think Lola has developed a UTI, her urine is very dark and foul smelling. The surgeon is starting her on an antibiotic today, he said he didn’t need to see her. She’s panting and seems uncomfortable. Hopefully she feels better soon. I’ve bought some pumpkin purée in case we get problems with stools from the antibiotic.
I actually never know what any vet will say or recommend, and you have a special case with an 85-lb dog, 3rd floor, and you're not much bigger than she is. I would just try to think ahead on the remote chance that they might decide to remove the catheter a week early. If by chance they decided that, do you have what you need in the way of a female-friendly walking harness or bedding that keeps a dog dry or potty pads to care for her without going up and down the stairs? I don't know, I just usually try to think, "OK, how could I prepare for this or that, just in case it's something unexpected."
Another option, if it is possible, is if you could take a couple of days off starting when she has her cather removed, so you can be home and monitor her and see if she is staying dry. The trouble is, if you are home you will probably give her more frequent potty breaks, so it would not be a true test of the number of hours she can go, unless you literally are home but do not potty her until the number of hours that would elapse if you were at work. But really, even if she can pass the test of the number of hours needed, I would still want safe bedding under her to keep her dry in case she has an off day. All I can say, and I can't say it strongly enough, is a pressure sore that starts as a urine burn is much easier to prevent than to cure.
If it was me, I would get some whelping bedding or fleece or whatever you can find that will best protect her, and I would just hope I am wasting my money, but if it saves her from a wetting even one time, it was money well spent. What happens with dogs is, if she wets the bed, the urine will normally gravitate to the lowest part of the bed, which is probably where her hip is pressing into the bedding. This is how the urine burn ends up on a pressure area. The other place people have reported urine scald is the boney part of the rear.
If you don't have the pass-through bedding but she is good about lying still, I would at least put a very large very absorbent diaper under her tail area so that hopefully if she leaks, it will catch it. You can get the diapers to lie flat by trimming the elastic edges. Again, you may know of something even better or have access to better supplies through your professional contacts. There was a link I thought I had saved and I can't find it right now, but it was from of a veterianary cart manufacturer a number of years ago, speaking of large dogs. If I can find it later I will post it. They basically said, the amount of money you spend on good bedding is nothing compared to the expense and grief of trying to treat a pressure sore. Only they said it better than that, because as vets they were speaking from experience.
It is a little confusing because there are whelping pads that resemble reusable underpads, and that isn't what I mean. The kind of whelping bedding I am talking about is a thick fleece where moisture passes straight through. You would put something like a puppytraining pad under it to trap the moisture (or one brand sells custom underpads to go with their fleece). Here is an example. It looks like this website is sold out but it gives a good explanation of how it works, with pictures. I'll see if I can find another one.
Here is another brand, with another explanation of the pass through feature of the fleece.
Then there is the Palace Fleece I mentioned before, the same idea. I'm not sure but I think it might be the thickest and this is the one I would get if it was my dog. It is especially for this kind of situation.