Pip diagnosis - Central cord syndrome

[CarolC]

Today just out of curiosity, I tried to see if he could drink water. He drank from the bowl 3 times. He was not enthusiastic about the water, but he didn't aspirate or do his little "Heh-heh" cough thing. I imagine by now he prefers soy milk, but I do wonder if he is able to drink plain water now. Will keep testing him. If he can drink water without aspirating, then he'll be able to do hydrotherapy. I didn't want him getting in the tank or pool and inhaling it and getting pneumonia, especially when he couldn't muster a good cough to cough it out.

Today he had his incision checked. I thought it was going to be suture removal, but he has absorbable. The intern who checked him was the same vet who cared for him during the 3 days after surgery. He says he's doing "phenomenal". He says now the thing to do will be PT. I told him we will but I'm not going to be in a hurry, we'll take it easy. He agreed.

I asked about his ligaments, whether they were better on one side of his neck than the other. He doesn't think so, he thinks it's just the way he's been lying. I think he meant it made one side more dominant. All I know is, his neck still pops.

I asked if he could have a bath yet. He said wait a few more days till the little scabs fall off.

While we were waiting for his appointment, one of the young techs walked by and remembered him and gave him a big smile. She had helped care for him. The girl at the reception desk remembered us and smiled. And the intern was super nice and gave a strong handshake as we were getting ready to leave. I think Pip is a star at the hospital.

He has one more check in 6 weeks.

[critters]

The last I heard was that plain, clean, municipal water can't give humans, at least, pneumonia even when aspirated. I don't get such publications anymore, so I have no idea whether or not the thinking has changed.

He sounds MUCH improved!!

[CarolC]

He had his first PT session 15 minutes ago. 30 seconds on his front legs, 30 seconds on his hind legs. We'll do a little bit every time I take him out to potty.

EDIT TO ADD: He got 3 exercise sessions today, his first day of PT following surgery. Not noticing any discomfort. Exercises were carry-exercises. I carry him in my right arm and exercise his feet with my left hand. He does weight bearing in my palm for the front legs and resistance for the hind legs.

[CarolC]

It has been 3 weeks and a day since surgery. He finished all his medicine. He still can't have a bath because the intern said all the little scabs (along the incision line) should fall off and they're still there. He seems like himself before surgery, only not kicking at his head anymore. He has scooted himself to the corner of his bed to elevate his head several times, which he did when uncomfortable. If you think of his food bowl as 360 degrees around, he only finishes about 280 degrees. I don't think he can bend his head enough to get the part stuck at the edge closest to him (he eats lying down). I just spin it where he can reach it and he finishes. Last night I put him on his potty towel near the carpeted kitty castle and he kicked his feet and scooted himself across the towel and hit his head on the base of the kitty castle with an audible thump. He seems to be OK. We are only at 22 days, hard to be patient, I want to stand him against the wall and try wall exerises, but I'm waiting to do anything but very light PT. He has all the movement in his legs that he had originally, and using them can wait a little longer. Too hot to do anything outside.

[CarolC]

I gave him a bath this week even though his little scabs still have not all fallen off. I mostly washed his body, not his neck. Here is his incision 7/11/23, 34 days after surgery. His recheck radiographs are Aug 1.

[critters]

I wouldn't have thought they'd have gone through the front. He looks great though!

[CarolC]

Yeah, it's a bit hair raising to think about. They can do ventral, like Pip had, or dorsal. If the surgery isn't successful and a second surgery is required, they do the opposite approach of what the first one was.

We've been having issues that I haven't been posting. Haven't even been taking good notes. He started acting painful maybe 10 days ago. He finished his meds weeks ago and seemed pretty good. Then 5-7 days ago he cried out in intense pain when I went to pick him up from the grass. It set off a pulsing in his lower right neck which as best I can tell was the jugular. It lasted several minutes. There have been 2 occasions of pulsing after pain. It became very tension-making to have to lift him and lay him down. He also has trouble swiveling to the left unless he's in a certain position. I started him back on leftover gabapentin 0.5 ml 2x/day. It has helped. We are also doing every urination standing up like we do first thing in the morning. That way I don't have to lay him down and pick him up.

I reported here he'd back-flipped himself out of his bed (about ~7 times now) but seemed OK. Don't think I reported I put him on his potty towel on the living room floor and he kicked his hind feet and scooted himself till he hit his head on the base of the kitty castle with an audible thump. He's never, ever done that before in the 2 years that I've had him, and I always put the towel there. He didn't cry out, but he had a look on his face. That was 2+ weeks ago. The change in his comfort and ability to turn his head has been since then but I didn't notice it right away, so I don't know if something else happened later I'm unaware of. For example, he spends the night in his playpen and I'm asleep and wouldn't know if he did something during the night. There has not been an obvious before-and-after where he did something and I could see a change right after that. I'm afraid maybe he broke his implants that day, then in subsequent days his neck moved with daily activities. But I have no experience with this and would be glad to be wrong.

His recheck is Aug 1. I'm just hoping he hasn't done something to the surgery. As far as I'm concerned he's still their patient until he passes his recheck, but I emailed 1) the neurologist 2) the reception desk where they do refills, and 3) the surgery department, telling them he was having pain and giving an update, and not one of them got back to me. Last night I literally had a nightmare on the theme of not being able to get what you need in order to do your job.

[critters]

Maybe he strained his neck a little that time. I would think they'd have used hardware more durable than a little knock, but you could always call & ask them.

[CarolC]

On the 14th I put him on gabapentin 2x a day because that was all his meds I had left, but it worked. Had a terrible time trying to communicate with the hospital to get refills on meds. Since Tuesday he's been on 1x a day. Last night for the first time, he finished his dinner bowl, getting all the sides without needing it rotated. His bowel control may be better. Twice I put him on his potty towel and he went right away, like he'd been just waiting. It seems like every day in the late morning he tries to tell me something. He puts his head down and ears down and talks at me 100% earnestly with eye contact, and I don't know what it is. It may be he's saying he's supposed to have his other dose at 10:30 am. I'm going to feel bad if I find out at recheck that he did something to his surgery, and I only gave him meds once a day. I don't see obvious pain in the afternoon and evening when last night's bedtime dose has worn off, but I see more wellbeing when he's on it.

EDIT TO ADD: This afternoon he drank enough water for a real test, and he is still doing his little "Heh-heh" thing after swallowing. Still aspirating.

[CarolC]

I would say he feels good the way I want him to today. Still on 1 dose of gabapentin at bedtime, it's 11am now. Don't know what's going on. Don't know why he didn't feel good before. Don't know why he does feel good now. Just. Don't. Know.

[critters]

Sometimes they're a mystery!!

[CarolC]

His last dose of gabapentin was on the 24th. He seems fine. But on the 25th he kicked himself up to the corner of his bed, lying on his right side, so his head was over the edge, his neck was resting on the edge, and his shoulder and body were inside the bed, stuck against the inside wall of the bed and unable to move forward. He was kind of high centered on the edge of the bed. He was kicking frantically trying to get out of that position. It was hard for me to figure out how to lift him because the rule since I got him is I DO NOT TOUCH HIS NECK so it took a few extra seconds to fix him. By the time I got him fixed he was doing the goldfish breathing. This is the first time he's done that indoors. We keep the temp at 80 degrees, so it wasn't hot, and he had been kicking rather furiously but I didn't think he was exercising as hard as he used to when he used to walk in the yard and then overheated and overexerted and started the goldfish breathing. It might have been partly panic this time. I don't know.

Yesterday I put him in his playpen and he springed himself into a sternal position against the net and appeared to bother him neck when he did it. He is insisting on doing his movements like he used to do, as much as he can, but I think sometimes he pays for them.

On the good side, his hind legs seem to be doing a better job when he is sternal. Wider stance, more stable, very cool.

[critters]

It seems to me that the breathing thing is probably emotional, but it sure sounds like he's doing great physically.

[CarolC]

Yes, partly from panic, I agree.

8-week recheck rads was yesterday. Not the best news. Some of his implants have broken. Don't know when it happened. I assume it was either when he hit his head on the cat tree, or flipping around in his playpen. This is after the neurologist assured me (when deciding on surgery) it was highly, highly unlikely it would happen, and after the surgeon said he was rock solid. To be fair, they were speaking to the best of their knowledge. She says she's never had this happen before. I said the lesson is don't do it on a dog with spasticity.

He still has some pretty good stabilization from the remaining implants and cement, and she wants to just go with that. She scarified the bones during surgery to encourage them to fuse. I asked if she could tell if they had, and she wasn't sure, possibly in one area. I guess as long as the other implants are holding, it can still continue to fuse. I'm glad he's on raw diet because he must be getting plenty of calcium.

She prescribed gabapentin for when he's uncomfortable in the late afternoon, with 6 months of refills. She said she would approve lifetime gabapentin for a dog with his history. He did better yesterday afternoon with a 3pm dose of gabapentin.

She wants us doing front leg exercises and range of motion. His hind legs have actually improved since the surgery. I've watched him get in a sternal position and then raise his rear a little and reposition his hind foot for a wider stance several times. He knows exactly what he's doing. It would be amazing if he'd get some improvement in his front legs. That would solve the bulk of the problem. They see improvement in some dogs after the spinal cord is decompressed. It's supposed to be less likely when it's been compressed a long time. If we had been given a correct diagnosis in 2021, we could have done surgery sooner. We'll see.

The only other thing is a little one, but I've noticed since surgery he sometimes belches just slightly when I pick him up. He must be swallowing air when he eats. He was restless this morning and I couldn't figure out why, and then he belched and relaxed. This has happened before. I'm thinking maybe I need to burp him after he eats? All it involves is picking him up and holding him a few seconds.

I asked her if they would shave his neck over the jugular when they sedated him for x-rays, and they did it. That was nice. Now I'll be able to monitor him for at least 2 more months to see if he has any more episodes of hypertension, or whatever was going on.

[critters]

Yes, strong spasticity absolutely can do stuff to bones; kids with spastic CP aren't uncommonly diagnosed with dislocated hips from the muscle imbalances. I hope it's less common now, but back in the 70s & 80s I knew kids with it.

It seems to me that 2 months is long enough that maybe there's some solidification there?