New, Lost, and Frustrated with Vet

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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Kait87
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New, Lost, and Frustrated with Vet

Post by Kait87 »

Hi everyone! I'm Kait and last Friday I came home to find my 7 y/o aussie mix Ivy had been attacked and wasn't able to move her hind legs. I rushed her to my local vet who recommended that I leave her for the weekend for steroids and fluids to see if she regained any function. I left the office devastated and didn't hear from anyone about her status until I called them Monday morning. I had done a little research and found a neurologist about 3 hours away that is highly recommended. When I spoke to my vet Monday morning I asked him if that should be the next visit and he said it wasn't a bad idea, but that there was nothing that could really be done now. I called the neurologist before I went to pick her up and the soonest they can get me in is the 18th which will be almost 3 weeks after her accident. The only way they could see me sooner is if my vet contacted them and gave a referral saying it was urgent. I talked to him about it when I got to the office and he basically blew me off and repeated that there is nothing that can be done so he didn't see the real hurry. I asked him if he could show me how to express her bladder since I knew I would have to do that for her and he basically pressed on her bladder from one side until some urine came out and was like, so that's how you do it. I asked him if there was anything else I needed to do for her recovery like put her on crate rest and he literally said," yeah that's probably a good idea". I asked for how long, like 6-8 weeks to which he responded, "that would be about right". He sent me home with antibiotics for some wounds she had from the attack, some steroids and some pain medication and told me to call if I had any questions.
When I got her home I was taking her out of the truck and had my arm under her hips and apparently I managed to press on her bladder which was not empty because the vet didn't actually show me anything, which resulted in her spraying urine all over the inside of my truck. When I got her in her crate she was gasping for breath and panting and every time she would inhale there was this loud thumping sound in her chest. I called in a panic to ask about the sound and he said, yeah she kind of thumps now, just try to keep her calm.
This morning I called to ask about constipation because after she didn't have a BM for 2 days I looked up how to stimulate her to poop and when she finally did it was small, dry, and hard and required a lot of effort on her part. I told him everything I'd been giving her, which included her daily wet food and he said well, I would start giving her wet food. He told me the only other option is a laxative they give to cats for hairballs.
To say I'm frustrated would be an understatement. Thank goodness for the internet and this forum because otherwise I would have no clue how to actually help her. At this point I'm just trying to get by for a couple more weeks until we can get in to see the neurologist, but even that situation is concerning because I am under the impression that we are now way past the window to do anything to help her and at this point I don't even know what her actual injury is. When I explained that to the office I was told that if my vet doesn't think it's an emergency then they can't see me before the 18th.
I live in a very rural area so there are not a lot of resources available. There are no physical therapists anywhere nearby so I have to figure out how that's going to work. I am open to any and all recommendations or advice you can give as I still feel totally lost.
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CarolC
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Re: New, Lost, and Frustrated with Vet

Post by CarolC »

Hi Kait87,

You need another vet. Right away. Today if possible. That's the way it sounds to me. He didn't even do an x-ray? :shock: You need a vet that will do exactly as you say and refer your dog right now. I know it's been a week but without a real examination and possibly advanced imaging, there is no way to say for sure that nothing can be done. I understand you are rural, but is there another vet practice you can call right now and ask to be seen on an urgent basis and ask that vet for a referral? Your idea of a referral is COMPLETELY reasonable and appropriate for this situation, and chances are any vet except this one you went to will see that. You are RIGHT. Don't LET THIS GUY try to BLOW YOU OFF. It is ridiculous that you are in this situation, but now I think you just need another vet. It is Friday, if they can't get you in to the neurologist today, maybe the specialty hospital could admit your dog and she could be seen over the weekend, as I imagine one of the vets at the specialty practice will be coming in over the weekend. If you can't get in to see another vet to get a referral, another option is to look online, find your closest veterinary college, call them, and see if they will take her.

Also, I have no idea what the thump is, but that is totally unnatural, I've never heard of that with any other dog here, but it needs to be checked. It is very concerning. SHAME ON YOUR VET for not even trying to find out what that is, and shrugging everything off. That guy is unbelievable. There have been some stories here of poor vet support, and this one is certainly in the top part of the list.

The panting sounds like pain. You said he gave her pain meds, so she may be having breakthrough pain and need something stronger or a different dose.

I dearly hope you can get her in to another vet who is actually competent and cares, and referred asap to the neurologist. If not, I hope you can get her in to a veterinary college.

It's all going to cost money. If you start to worry about the bills, there is a loan for emergency veterinary care through Care Credit. The terms are good and people are usually approved. I haven't heard anyone ever say anything bad about them. Chances are the specialty place will have the application available at their reception desk. You fill it out and they let you know if you are approved almost right away.

It is 10:30 AM where I am. I hope you can get her a better exam today and find out what is going on and what to do next. It is true that surgery is less likely to be effective the longer you wait after paralysis, but with everything else you have said about the vet who examined her, I don't even trust him to assess whether she is fully paralyzed or not. Sorry, maybe I am wrong, I am not a vet, but that's my impression from what you say, and a situation like this does not deserve to be blown off if the owner is willing to pursue additional diagnosis and treatment.

Also, it sounds like he is talking about petromalt or laxatone when he says hairball remedy for cats. There are other medications that can be used to soften stoods, such as lactulose syrup, which it seems like he would have available and could have offered. It comes in a bottle, is not overly expensive, lasts a long time, is not habit-forming, and you can adjust the dose to get the stool quality you need. It makes me think this vet can't even treat constipation. Some people here have used plain canned pumpkin (no spices) to improve the stool quality. Also try to be sure she's drinking enough water.

I hope you will post back, to say if you were able to get her seen any sooner.

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critters
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Re: New, Lost, and Frustrated with Vet

Post by critters »

Yeah, I'm with Carol--if he doesn't even know what else is available for constipation (not that the Petromalt-type stuff is a bad choice, just NOT the only one), I'd wonder what else he's missing. Expressing is rather an art, but there's no excuse for not making a decent effort to teach you how to do it. I thought a full bladder felt like a water balloon, which it is. Once I figured that out I was on the way! Also know that there are meds that might be helpful with the bladder.

:whale:
Kait87
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Re: New, Lost, and Frustrated with Vet

Post by Kait87 »

Thank you both. I've been worrying that maybe I was just being overly sensitive because of the situation. I'm glad I'm not overreacting. It's just so frustrating because he has always been a good vet up until now. I really think he disagrees with my decision to keep her. I'll figure out what is available in my area. I know there is an emergency vet a couple hours away so I might just take her there if I can't find something else. Thanks again. I'll let you know what the outcome is when I know more.
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CarolC
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Re: New, Lost, and Frustrated with Vet

Post by CarolC »

That kind of attitude used to be more common among vets. Fortunately things have gotten better and it is less common nowadays. I hope you can get her seen. You need a better idea of what is going on. Did she actually get bit on the spine by the other dog? Will be waiting to hear what you find out.
Kait87
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Re: New, Lost, and Frustrated with Vet

Post by Kait87 »

I currently have an appointment with a specialty vet 3 hours away on the 18th which is the soonest they could see her without a referral. My husband's cousin, who is a vet tech, also recommended a different specialist who's a bit closer so I'm going to call them tomorrow when they open and see if they can see her sooner. I don't want her waiting almost 2 more weeks if she doesn't have to.

She has a few bites around her neck and a bad one on the inside of her back leg. My theory, which is probably wrong, is that she got into a fight with something and at some point it got her by the leg. I figure she either whipped around to fight it off or whatever got her shook her and she hurt her back at that point. I honestly don't know though. By the time I found her it had been at least a couple hours and she had obviously been attacked away from our house and she drug herself back up to the house.

She's a working dog so her and our other herd dog are put out in the pasture with the livestock every morning. Of course none of them are going out right now.
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CarolC
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Re: New, Lost, and Frustrated with Vet

Post by CarolC »

OK, that is really good that you have someone in your family in the veterinary field. I hope the other vet she recommended can get you in. If they also need a referral, I wonder if the vet tech's own vet could examine her and refer, to get this moving. I hope the call tomorrow morning works out.

The description of the injuries does not seem to give a clue of what the thumping sound might be.

I thought there were some vets who could tell what kind of animal attacked by the marks that were left. You don't know if it was a bear or a coyote, or even a large dog dumped on a county road by an unemployed person in the city. I wonder if any neighbors have heard of any other incidents.
Kait87
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Re: New, Lost, and Frustrated with Vet

Post by Kait87 »

The vet said it was canine, and based on where I live it could have been a dog, but was most likely a coyote. We have a den on the hill behind our house and we actually lost a barn cat the week before to them. We have a guardian dog, but she's old so she's mostly retired while she lives out the rest of her life. We were actually in the process of getting another, but now that's been put on hold until we have this whole thing figured out. I don't think I can train a new puppy while I'm learning all this.
Now I'm actually down 2 working dogs and my 3rd is still young and learning so she's kind of lost at the moment.
The good news is that we have an appointment at the new vet for this Thursday. I'm hoping they can give me a diagnosis and a treatment plan so I know I'm doing the right thing. So far we're getting by, but I'd like to know what's actually wrong with her. She's being so patient with me though. She's such a good girl.
Kait87
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Re: New, Lost, and Frustrated with Vet

Post by Kait87 »

A new update on Ivy. I called the specialist my husband's cousin recommended as soon as they opened yesterday morning and they originally made an appointment for this coming Thursday, but this morning her records came from our local vet and once the specialist reviewed them she called and asked that I bring Ivy in ASAP. I loaded her up in the truck and we made it there about 2 hours later.
I went over everything that our primary vet told me and what my concerns were, including her breathing problems and noises that my vet told me was her new normal. They took her back for imaging, which the primary vet did not do. After blood work and x-rays they can't find an obvious injury on her spine. They said we could do an MRI next, but the far more pressing issue is a large hernia they found in her diaphragm. They think this was also the result of trauma sustained during the attack since she's never had breathing issues before. The hernia is currently letting her internal organs slip into her thoracic cavity limiting her lung capacity and those times when I was worried because she was acting like she couldn't breath, she was literally suffocating and my vet blew me off. Since it's been a week and a half since the attack, whatever damage to her back is more than likely irreversible making the hernia and her breathing the obvious priority.
She is at the vet for tonight. They were able to manually move her organs back where they belong so she can breath comfortably and they have her positioned and sedated so they will stay there. Tomorrow morning she'll have surgery to fix the hernia.
Once she recovers from this surgery we will discuss further diagnostic testing to determine the spinal injury. The vet is kind of on the fence about if it is really necessary at this point. Yes it will tell us for sure what the actual injury is, but structurally she is sound and at there is basically no chance that she will regain function of her hind end. Regardless of what the MRI shows, she will be paralyzed and we will need to deal with that reality. The vet said that the other concern with injuries like this is that there is some type of inflammation that can set in above the injury causing damage from the point of injury towards the brain and that once it reaches the nerves controlling the diaphragm it would be fatal, she had a name for it of course, but by that time I was so overwhelmed with everything else I can't remember what it was. She said the good news is that if this were going to be a problem, it usually starts to do damage within the first 5 days and since Ivy is on day 12 with no signs, she feels it is very unlikely.
She did test Ivy's reflexes and they were good, but she has no deep pain sensation. Another reason the vet feels that it is too late for any type of surgical intervention for her back. She told me the next step is to figure out what we want to do, and they'll help me order a cart for her and get her set up with the right medical support to keep her happy and healthy. I just need her to survive this surgery tomorrow. If she does that, we can get through the rest of it together.
I just keep wondering if I'm doing this for the right reasons. She will be 8 years old in August, but cattle dogs like her have a normal lifespan of 15 years so she could have half her life ahead of her still. I just hope I'm not putting her through a bunch of unnecessary pain just because I'm too selfish to let her go peacefully. I hope once this is all over she can still have a happy and well adjusted life.
I'm really relieved that out of 3 vet offices, one of them took my concerns seriously enough to make her a priority. I can't believe she didn't die. I also want to thank you all here for the support and feedback you've given me so far. It takes a lot of pressure off knowing that I have somewhere I can go for help from people who have lived through this. I'll keep updating as I receive more information.
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CarolC
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Re: New, Lost, and Frustrated with Vet

Post by CarolC »

This is such a relief I could just about cry. Thank goodness! So that was the thump. I love the way that vet called you straight in when she got the records. Your other vet totally missed everything. Usually the specialist will send a report back to the referring vet, and I hope he reads it and sees what he missed.

The condition you mentioned that sometimes occurs and affects the diaphragm is called ascending-descending myelomalacia, or just myelomalacia. Fortunately, it is uncommon, and I like the way she explained that you'd likely have seen signs by now. I think she just wanted to you to know there is nothing they can do about it if it happens. The vet told me that same thing about my dog, so of course I worried. One of our moderators, BethT, was told by a university veterinary hospital that her dog actually had it, and it turned out he didn't.

If this vet said there is no deep pain sensation, and it's been this long, then everything I've heard suggests surgery won't help. Surgery is most effective if done early, preferably within 24 hours of loss of deep pain. Often vets don't do (expensive) advanced imaging unless the plan is to take the dog directly into surgery if the imaging indicates a problem that could be helped by surgery, so what she said is not unusual. [EDIT: See next post]

If she is fully paralyzed, then it probably means you will be expressing her bladder about every 8 hours for life. It takes about 5 minutes, and that is no problem as long as someone can be home 3x a day. It is something you get used to and it becomes your new normal. I do not know if she is leaking or dribbling at all, but that can also be dealt with.

My question right now would be, were you expressing her previously in a standing position? It may need to be done in a lying position following the surgery. There are a number of videos at the end of this link that can give demos of expressing in different positions. Scroll clear to the end of the article.

viewtopic.php?f=5&t=16027

Since she is a working dog and probably in excellent athletic condition, I would think she would be in good physical shape to use a wheelchair. At least after she recovers from her hernia surgery. I'm not sure how long that will take. They make carts with large all terrain wheels. Dogs here have gone hunting in a cart. Stacy's dog, Blue, was a working dog. He helped her herd 2-4 hours a day. Dogs can't stay in a wheelchair all day, they need to be taken out after a reasonable time to rest and prevent sores. But they can do most of what other dogs do when they are in the cart.

viewtopic.php?f=10&t=2751#p12342

I will mention something else, that I don't know if the vet mentioned. There are some dogs who can learn a kind of walking even when they are fully paralyzed. It is called spinal walking. The dog's body has a system that when the front legs move, it fires a reflex in the hind legs, and that reflex continues to work even during complete paralysis, and some dogs can learn to use this to walk. Some figure it out, or some learn it through extensive physical therapy.

But right now you just have the immediate situation to deal with. I am SO glad you got a good vet and SO VERY glad they got you right in. I do not think you are being selfish with a healthy, athletic 7-yo dog. I am so glad you were able to get her the help she needs. I hope she will recover quickly.

(((Big HUGS))) to Ivy and her family!

:grouph:
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CarolC
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Re: New, Lost, and Frustrated with Vet

Post by CarolC »

Sorry, I had another thought, and the previous post I just wrote was long so I'm double posting.

There are many kinds of spinal injury, and I am not a vet, but it may still be worthwhile to have the MRI. If you can really afford it, I would consider it. However, you're going to have a pretty big bill without it. But anyway, this is my nonprofessional layman's explanation.

There is IVDD (intervertebral disk disease) which is a disk injury (herniated disk, ruptured disk), and that is the one where they say if there is full paralysis then the sooner you do surgery the more likely it is to have a successful outcome.

There is another kind of spinal injury that also results in full paralysis, and it is called FCE (fibrocartilaginous embolism). FCE is also called a spinal stroke because there may be a bleed around the spinal cord at the location it occurs. It often occurs while the dog is doing something athletic, like flyball for example, and goes down suddenly (but sometimes occurs without such an event). You can't do surgery for this, but the great majority of dogs recover spontaneously.

Then there is a third condition called ANNPE (Acute Non-progressive Nucleus Pulposus Extrusion). It is a high velocity disk extrusion. You may want to read this explanation. The majority of ANNPE dogs also tend to recover, like FCE dogs, though they are more likely to remain incontinent (they can walk but still need to be expressed).

https://vth.vetmed.wsu.edu/specialties/ ... l-injuries

The point is, all 3 of these conditions can result in a fully paralyzed dog, but FCE and ANNPE are likely to improve and the dog walks again. It would be great if you could have a better idea of the actual injury. The x-rays ruled out a spinal fracture, so you know her back is not broken. An MRI could help you identify if there is a bleed or see if there is any kind of disk problem. ***If*** you really can afford it, I would do it. If not, then basically you will be caring for her in the coming weeks/months and if she begins to show signs of improvement, you will notice. In that way, you may begin to suspect it was FCE or ANNPE, even though an MRI was not done.

I don't know. Please discuss this with the vet, because she will be able to explain it better and help you with the decision making. Just thinking out loud here. Your dog was grabbed by the back leg and whipped around, possibly even pulled between 2 dogs, nobody knows. If you have any rough areas on the property with rocks or outcroppings or gullies, she might have fallen, too. Anyway, it may not be IVDD, and it could be helpful if you could have a better idea of what it is, but only if you can afford it.

[EDIT TO ADD] I just read that a common incision for diaphragmatic hernia repair goes all the way down the midline to the pubis. I am not sure how you would express her bladder with the incision all the way down. I expressed following spay surgery, but the incision was not all the way down. I wonder if they will send her home with a catheter for a few weeks so you don't have to express.
https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11181&catId=30097&id=3852320 wrote:A midline abdominal celiotomy (xiphoid to pubis) is the easiest and most versatile approach.
There was a dog here named Zoe. Zoe was hit by a truck, broken leg and broken pelvis, and her intestines ruptured through her abdomen. She had emergency surgery to repair and replace the intestines, but they stitched part of her bladder, so she had a second surgery to repair the mistake, then she had to be expressed. Here is what worked for expressing her, but you would have to ask the vet of course.
https://handicappedpet.net/helppets/viewtopic.php?f=10&t=3135&p=14385#p14385 wrote: What a wonderful day today!!!
I called up to Medvet and told them about the problem we were having expressing her.
The nurse told me to try taking her out in the yard and placing her sling under her and lifting her slightly off the ground with it, this way the pressure would be across her whole abdomen without too much direct stress on her wounds.

IT WORKED!!! She urinated seven times throughout her walk. We were so happy we were crying! LOL The small joys in life, right?
Not only that, but she was trying to use her bad leg walking, it was just wonderful, she enjoyed it and she went. It was great.
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critters
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Re: New, Lost, and Frustrated with Vet

Post by critters »

CarolC wrote: Fri Jun 05, 2020 5:37 pm That kind of attitude used to be more common among vets. Fortunately things have gotten better and it is less common nowadays.
I completely agree.
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Re: New, Lost, and Frustrated with Vet

Post by critters »

Kait87 wrote: Tue Jun 09, 2020 7:06 pm A new update on Ivy. I called the specialist my husband's cousin recommended as soon as they opened yesterday morning and they originally made an appointment for this coming Thursday, but this morning her records came from our local vet and once the specialist reviewed them she called and asked that I bring Ivy in ASAP. Great!I loaded her up in the truck and we made it there about 2 hours later.
I went over everything that our primary vet told me and what my concerns were, including her breathing problems and noises that my vet told me was her new normal. They took her back for imaging, which the primary vet did not do. After blood work and x-rays they can't find an obvious injury on her spine. They said we could do an MRI next, but the far more pressing issue is a large hernia they found in her diaphragm. Yes, that can happen. The belly organs can slide up so slowly nobody notices.They think this was also the result of trauma sustained during the attack since she's never had breathing issues before. The hernia is currently letting her internal organs slip into her thoracic cavity limiting her lung capacity and those times when I was worried because she was acting like she couldn't breath, she was literally suffocating and my vet blew me off. Since it's been a week and a half since the attack, whatever damage to her back is more than likely irreversible making the hernia and her breathing the obvious priority.
She is at the vet for tonight. They were able to manually move her organs back where they belong so she can breath comfortably and they have her positioned and sedated so they will stay there. Tomorrow morning she'll have surgery to fix the hernia.
Once she recovers from this surgery we will discuss further diagnostic testing to determine the spinal injury. The vet is kind of on the fence about if it is really necessary at this point. Yes it will tell us for sure what the actual injury is, but structurally she is sound and at there is basically no chance that she will regain function of her hind end. Regardless of what the MRI shows, she will be paralyzed and we will need to deal with that reality. The vet said that the other concern with injuries like this is that there is some type of inflammation that can set in above the injury causing damage from the point of injury towards the brain and that once it reaches the nerves controlling the diaphragm it would be fatal, she had a name for it of course, but by that time I was so overwhelmed with everything else I can't remember what it was. She said the good news is that if this were going to be a problem, it usually starts to do damage within the first 5 days and since Ivy is on day 12 with no signs, she feels it is very unlikely.
She did test Ivy's reflexes and they were good, but she has no deep pain sensation. Another reason the vet feels that it is too late for any type of surgical intervention for her back. She told me the next step is to figure out what we want to do, and they'll help me order a cart for her and get her set up with the right medical support to keep her happy and healthy. I just need her to survive this surgery tomorrow. If she does that, we can get through the rest of it together.
I just keep wondering if I'm doing this for the right reasons. She will be 8 years old in August, but cattle dogs like her have a normal lifespan of 15 years so she could have half her life ahead of her still. I just hope I'm not putting her through a bunch of unnecessary pain just because I'm too selfish to let her go peacefully. I hope once this is all over she can still have a happy and well adjusted life.
I'm really relieved that out of 3 vet offices, one of them took my concerns seriously enough to make her a priority. I can't believe she didn't die. I also want to thank you all here for the support and feedback you've given me so far. It takes a lot of pressure off knowing that I have somewhere I can go for help from people who have lived through this. I'll keep updating as I receive more information.
Good luck!
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Re: New, Lost, and Frustrated with Vet

Post by Kait87 »

Ivy is home! I can't even begin to express how happy I am.
She did so well during surgery and recovery that they were actually able to remove her chest tube and send her home the next day instead of her staying 2-3 days like they expected. We still haven't decided on the MRI, and we're going to discuss it at the follow-up appointment in 10 days. The cost of the diaphragm surgery set us back pretty decently and we need a little time to decide if we can come up with the money for the MRI. The team discussed further and all agree that it would be helpful to know exactly what her injury is, but that it is highly unlikely that it will change her outcome or treatment plan. It's too late to do any type of surgery or anything else of that nature to correct the problem so it's not going to make much of a difference. Therefore they are leaving it up to us and recommend that we move forward assuming she is a permanent paraplegic. They measured her for her new wheels while she was there and recommended a company that they prefer. I know she won't be able to use them for a bit, but it's a custom wheelchair so we are going to order it now so it's ready when she is.
Some positive news is that it looks like she actually still has control of her bladder. I didn't know how to tell and the first vet told me I would have to express her forever so I just assumed that was the case. Yesterday when they were bringing her out to the car however, she was walking in a sling and when she got to a grassy area she released on her own. I'm still expressing her for now because her incisions make the sling very uncomfortable, but next week when she's healed up a bit, we are going to see if she will continue to go outside if she's taken out. Fingers crossed, but I'm honestly good with it either way.
Today marks 2 weeks since the accident and for the first time she is resting comfortably and breathing easily. She was so calm and comfortable last night I was actually able to sleep in my own bed instead of in the living room with her. Her medication schedule still has us up throughout the night, but that's hardly an issue. We just have to get through the recovery from this surgery over the next 10-14 days and we will be well on our way to living a new, but happy and healthy life.
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Re: New, Lost, and Frustrated with Vet

Post by CarolC »

This is great news, and you guys have the most wonderful attitude. It makes sense from a pragmatic standpoint not to do the MRI, because if she begins to improve you will notice any signs of improvement with or without the MRI.

The first vet who said you would express for life may have simply been wrong, or he may have been right based on her signs at the time he said it, but her neurological status may have changed. Her current vet also said no deep pain sensation on the intake exam, but in that case I would not really expect voluntary urination. I know you want to see if she continues to do it later when you can take her out, but that is very exciting.

This is a tip you may or may not need. One thing you see in some dogs as the nerves recover is chewing. They may lick or chew their toes or other areas. The theory is it's a pins and needles sensation like humans feel if you sleep on your arm funny and it goes to sleep, then starts to wake back up and tingles. It can become a problem because some dogs do not stop even if they draw blood and injure themselves, which can happen pretty quickly. There is medication that will control it (either gabapentin/Neurontin or pregabalin/Lyrica). Be sure to tell the vet if you notice licking or chewing. Not all dogs do it, it is a temporary phase some dogs go though during recovery.

So glad she is comfortable now :sleepingdog: , and you can sleep! :snooze:

I would love to know how this turns out in the long run. Very best wishes for her recovery.
:angel:
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