Labrador L5 IVDD post surgery

Neurological Disorders Resources. Treatment and care for pets having pain or trouble walking or standing due to spinal injuries or neurological disorders like IVDD, FCE and DM.
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CarolC
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Re: Labrador L5 IVDD post surgery

Post by CarolC » Thu Jun 13, 2019 8:44 pm

Hey there,

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

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Re: Labrador L5 IVDD post surgery

Post by critters » Fri Jun 14, 2019 1:54 pm

I don't remember whether we tapered gabapentin or not, it's been so long.

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!

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Re: Labrador L5 IVDD post surgery

Post by CarolC » Sat Jun 15, 2019 3:51 pm

I'm curious what happened when she pulled her catheter out those two times. Do you know how long it was out? Was her bed dry when you came home? Did she void a lot when you had to carry her out to the car to have it replaced?

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.
:sleepingdog:

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Re: Labrador L5 IVDD post surgery

Post by Lolalab » Sat Jun 15, 2019 6:46 pm

The first time was my fault, I started to take her outside and I didn’t detach the cath and it pulled out :( bulb was inflated. She didn’t whine tho.
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.

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Re: Labrador L5 IVDD post surgery

Post by Lolalab » Wed Jun 19, 2019 1:19 pm

Question re: physical therapy.
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.

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Re: Labrador L5 IVDD post surgery

Post by CarolC » Wed Jun 19, 2019 7:54 pm

Here is an example of something that sounds similar? mud99's dog had stiff legs for "quite a while" but got over it. You kind of need to read the whole thread top to bottom to follow it all, but here are excerpts of the question and answer.
viewtopic.php?f=4&t=18783&p=96949#p96949
by rosalind50 » Sat Feb 21, 2015 8:55 pm
I read some of your posts mudd99 about Frenchie. That pic of him with those straight legs after surgery is what I've been looking at for almost 6 weeks. When did your dog start to bend them?
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.
That's really-really good about the standing, woohoo!!! :hurray:

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Re: Labrador L5 IVDD post surgery

Post by CarolC » Wed Jun 19, 2019 9:50 pm

Sorry for the double post but here are a few more.
viewtopic.php?f=4&t=13011&p=67936#p67936
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.
viewtopic.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.
2 complete posts by Jacko's Mum
viewtopic.php?f=4&t=14245&p=75031#p75031
viewtopic.php?f=4&t=13947&p=75030#p75030
viewtopic.php?f=4&t=11360&p=57557#p57557
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! :snoopy:
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. :D 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
There are probably more...hope this helps. :D

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Re: Labrador L5 IVDD post surgery

Post by Lolalab » Sat Jun 22, 2019 11:36 am

SO!! The PT team told me lola stood up by herself on Thursday!! They said it was very awkward and crossed legs and once she was up she needed help, but I’m so so happy she did that!!
We will get the urinary cath removed July 11, and then she can start hydrotherapy :)
Small victories!
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.

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Re: Labrador L5 IVDD post surgery

Post by critters » Sat Jun 22, 2019 5:47 pm

That's great! :hurray: I don't know about the weight-shifting and all. I wonder if you can try testing a little to see which leg might be stronger now? It might be too soon to really tell.

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Re: Labrador L5 IVDD post surgery

Post by CarolC » Sun Jun 23, 2019 11:22 am

Woohoo!!!!! :newyear: :elephant: :snoopy: :clap: :cheer: :bounce: :party: Yay Lola!!!!!

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!!!!!

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Re: Labrador L5 IVDD post surgery

Post by Lolalab » Sun Jun 23, 2019 2:38 pm

Thanks again for the replies!
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.

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Re: Labrador L5 IVDD post surgery

Post by CarolC » Sun Jun 23, 2019 4:17 pm

Is it amoxicillin? That usually works for my dogs and you often see improvement in only a few days. If you don't see improvement in a few days, she may need to actually be checked in case it is some kind of bug that needs a different med. Hopefully her tummy will be OK. Acidophilus is another treatment some people use with or after antibiotics.

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."
:thinking:

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Re: Labrador L5 IVDD post surgery

Post by CarolC » Thu Jun 27, 2019 11:30 am

I'm still concerned about the next few weeks for Lola. You have an indication she has some bladder control. but no way to be certain how many hours she can go without needing a potty break. With her personality, I would think if there is any way she can avoid wetting the bed, this is the dog that will do it. But I would think even with a dog with full bladder control, there is the fact that she's had a catheter for weeks and the possiblility that it could have a temporary effect on her sphincters when it is removed. I say this based on my grandmother who was catheterized in hospital for a length of time with a broken hip and afterward she had to do Kegel exercises to regain her previous degree of bladder control. So what I am saying is, I feel sure Lola will do her best not to wet her bed, but I would be completely ready for the possibility just in case. It would be unthinkable for her to be on the road to recovery and standing up on her own, and for you to do this much nursing care (and the expense), and for everything to be on course for recovery, and then suddenly have her get a urine burn after the catheter is removed because she can't hold out the number of hours needed before you come home from work. Then you've got a dog who can only lie on one side while it is healing, and it may not be the side she likes.

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.

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Re: Labrador L5 IVDD post surgery

Post by Lolalab » Sun Jun 30, 2019 1:39 pm

Luckily my boyfriend works from home and will be able to take her out frequently. (Also, the living room is on the ground floor, bedrooms upstairs...so now we basically live 100% downstairs). What is whelping bedding? Currently she is on an egg crate mattress, covered with a trash bag (in case there is ever a wet situation), and covered with a very soft fluffy blanket. I have a spare blanket that I rotate with when one needs washing. She is getting her cath out July 16, and I have that day off work. I’ll probably start her with hydrotherapy 2 days later, while I’m at work.

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Re: Labrador L5 IVDD post surgery

Post by CarolC » Sun Jun 30, 2019 11:02 pm

What a relief to know you are not on the third floor and have help! Yay!!!

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.

http://www.puppybox4u.com/VetFleece.html

Fleece.jpg
Here is another brand, with another explanation of the pass through feature of the fleece.

http://www.breederbase.com/WhelpingBox/WhelpingPads.htm

whelpingPads.JPG
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.

https://www.usaknit.us.com/category-s/75.htm

Palace_fleece.png
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