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Frenchie w/ Stage V 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.
frenchiepup
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by frenchiepup »

She got debrided this morning and now has basically what resembles a large sweater of bandages on her front half. Poor pup. Thankfully, they did comp the procedure. They still didn't commit to what they think caused it. They kept saying "pressure," but when I asked for clarification on that (bed sore pressure? Really?) they said it probably was something that started in the surgery and was exacerbated by pressure. In any case, since they covered the charges to treat it, I didn't press the issue too hard.

I will take her back to NYC tomorrow, but for the next few weekends we'll need to go out to CT for follow up on the wound, as they want their surgery team to do the first few dressing changes. It's a pain, but hopefully they can transition her over to the primary vet after a couple of weeks.

My dad, god bless him, looked after her the last two days, as I had to be in the city to start the school year. He had a very difficult time expressing her. Felt that it required all the arm strength he could muster. I always found the expression okay, but talking with him more I did become more aware that I use a lot of muscle when doing it. So my dad and I went to pick her up today after the procedure and asked the tech for another demonstration. She was easily able to do it, and using only two fingers in each hand (she "squeezed" with index and pointer of each hand while holding the bladder in place with her ring finger and pinky)! So clearly we aren't actually locating the bladder very well. I've always been able to get urine, but not so effortlessly as this tech (I get that it takes practice). I've watched about every youtube tutorial and read every article online about this, but if you have any secret tips on locating the bladder on a female dog, that would be appreciated. Having my parents be able to take care of her once in awhile significantly relieves some of the stress I've been feeling, but they are getting up there in age and I can't ask them to do it if it's going to cause my dad to pull a muscle!
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CarolC
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by CarolC »

It is a tremendous relief that they did not have to graft any tissue. You still have a lot of TLC ahead and careful handling, but it's less pain for her and hopefully her fur/coat will be OK.

I am glad they are semi-admitting it (under their breath while simultaneously throwing out misdirection) and covering the cost. I hope they weren't implying that it would have healed just fine if she hadn't laid on it. I don't always suspect people, but in this case I wonder if either the vet or the vet techs were aware of it at the time and sent her home anyway, and by the time you figured it out it would be all too easy to blame the owner. Almost nobody would realize it could be related to a cautery pad. You probably scared them to pieces when you even mentioned it. Just think how crushed a loving owner would be to have their dog develop a patch on the skin and then be told it was a pressure sore and all their fault. They wouldn't know any better and might think it really was their fault, and they let their dog down, and they just can't do this. However, I have a feeling either someone was disciplined, or someone was retrained, or equipment was checked, or something was done internally at that practice, because you gave them such a bad scare that they won't likely do that again any time soon. And you'll be going back for changes, and they'll have plenty of time to think about it every time you go.

Regarding your dad, sure don't want him pulling anything(!) :wink: It sounds like another reason to consider a trial of phenoxybenzamine (or other medication to relax the sphincter). It's an upper motor neuron bladder, it's going to be tight to express. I'm impressed by that vet tech. Perhaps the bladder was very full when she did it. A full bladder can be easier to express than a nearly empty one.

Another option for your dad is what we call Martha's Method. It was first described by Martha, who was advised to use it by her vet. Instead of expressing with your palms or with your hands flat, make fists. You get more pressure that way.
https://handicappedpet.net/helppets/viewtopic.php?p=13982#p13982 wrote: I am also trying to learn this skill of expression and what has helped me as a woman is actually making a fist with each of my hands and either using the open face of my fist(thumbs pointing forward) or knuckle to knuckle (thumbs pointing toward me when expressing. Perhaps I didn't have the strength in my palm and fingers or I was putting too much pressure on the finger tips, but I had no luck expressing until I used my whole fist which allowed me to use more pressure spread over a larger area than just my fingertips. All the advice written here about positioning with a very full bladder seems accurate. Overcoming the spincter is the hardest part so firm pressure is necessary in the beginning and once you get your dog going you'll have no more trouble. I express all I can, wait a moment and then do it again with duplicate results say 10 or 12 times each session. You can only feel the bladder when it is not abnormally distended. Just find the spot that works for your dog and repeat the actions numerous times each session. I asked a vet at our local veterinary teaching university hospital if this method was OK and he said many of the women students use this method.
As for where the bladder is, my guess is if you can't find it, it is probably riding high inside the abdomen way up near the spine. NOT down in the middle of the belly, neatly centered as you so often see in anatomy pictures.

If simply looking higher up (near the ceiling of the abdominal cavity) doesn't work, then I would try looking farther back toward the tail. NOT neatly centered halfway between the ribs and the pelvis, as you so often see in anatomy pics.

In my experience, the smaller the bladder is, the more likely it is to be high and near the tail. If it is half full, it occupies more real estate, and you are more likely to find it kind of centered about where you might expect, because now it has half filled that space. However if it is really full, again you're not going to find it. All you will feel is a belly that is big and tight as a drum, kind of like a pregnant woman's belly. The bladder is filling the whole belly and there is no outline to discern.
frenchiepup
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by frenchiepup »

I will discuss the medication with the vet, but I'm not so sure. The hospital reported multiple times that she was an easy express, and she actually wasn't that full when the tech gave us the demo. In any case, last night before bed I tried to more actively feel it with just one hand, in a C shape, etc. I got something that I thought was it, and gave it a squeeze. Pee came right out! I remember thinking that if it was that easy every time, neither me nor my parents would ever have a problem. But of course, then I lost it. I had to get the rest out by sort of squeezing the abdomen towards the tailbone, which requires a lot more effort/hand strength and isn't nearly as "precise" as just locating the bladder definitively. The same sort of thing happened this morning - felt something that I wasn't quite sure was it, and pee came out with very little squeezing effort on my part. But it wasn't empty after that and I couldn't locate it again, so had to revert to the other method.

I appreciate the tips on locating the bladder, however. I think it's probably located higher than where I typically feel.
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CarolC
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by CarolC »

If they say she's easy to express, I'll take your word.

The C shape is the method I use. I sometimes describe it as a lobster claw method, because I keep my fingers firm in a C shape and drive my fingertips up beside the bladder, and then walk my fingertips over the top, trapping it in a pincer movement.

When you have your fingers in this position and close your hand, it brings the bladder down into your palm and you are squeezing it in 3D. It works for a slender-built dog that is not too big. It helps to have long fingers.

People do not realize that you can move the bladder around inside the abdomen to a degree. You can use your fingers to fish it down from high up against the spine, moving it closer to the underbelly where you can encircle and squeeze it. It goes right back to its original position after you empty it, and you will have to go back up and fish it down again if it didn't get fully empty the first time. (Using the express-rest-express method to be sure she's empty.)

If you notice in this video, I am not merely wrapping my fingers around the outside of the sides in a C shape. I am digging or poking my fingertips into the softness of the abdomen in a deep palpation. My thumb is pushed in almost to the second knuckle. The bladder inside there is firm and holds its shape, while the sides I'm burying my fingertips in are comparatively soft and pliable and let you do it.



Inside the abdomen when you are pushing your fingertips up over the bladder, there are some ligaments or something that you have to work around.

I did one other video for somebody, using a stuffed toy, attempting to show how I bury my fingertips in the abdomen.



In the video you see how far I push in, so my fingers are buried in a ditch between the white part and the spotted part. Do you see the little x on the tummy? By the time I am done pushing in, the x has popped out. That is where the bladder is. My fingertips are behind the bladder. (I guarantee it can't escape when you do this.)

I agree about "precise"!

How does she seem to be feeling after her procedure?
frenchiepup
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by frenchiepup »

Thank you so much, Carol. The expression is still a bit hit or miss right now. When I can stumble upon the bladder with my hand it comes out no problem. The issue is the finding of it. I've felt things that have felt vaguely like water balloons, but never something that I would call "firm." I usually can get one squeeze out with one hand, but after that have to just push caudally with both hands in the abdominal region near the legs and hope for the best. Usually I can get a few good squirts that way. I just wish I felt more confident about finding the bladder and keeping it in place. I'll probably need to ask a tech for another demo. At least I'm still getting something out. And her poops have remained good!

She seems okay after the procedure. She's on gaba 3x a day and I do think she experiences some amount of sedation from that - that's fine with me, as she's still on bed rest orders for the next month. Her bandage looks like a large upper body cast, but I guess that's good so she can't rip it off inadvertently.

We got back to NYC yesterday. I took her outside to sniff a bit and she loved her old yard. She seems pretty confused about the whole situation, but I think will figure it out once we can start doing things again.
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by CarolC »

I'll bet she's very glad to be home. I guess they didn't think she needed an e-collar. I was wondering if she would need one. There are medical pet shirts designed to prevent chewing of bandages so the dog doesn't have to wear a cone.

Sedation sounds good. I have a dog on gabapentin right now. This is my first experience with it. It's the liquid formulation (veterinary). The vet said I could mix it with food, which we've been doing. It has a peculiar smell that seems to evaporate if you wait a minute after you mix it.

I'm glad she seems OK. My one dog is a little high strung and it's hard when she's sick, she cries. I'm glad if your dog isn't doing that.

On the expressing, really, honestly, at this point you're doing well if you are getting her expressed in any way, shape or form. It's the people who can't even get a little that I really feel for, but you were able to do it from the beginning. As long as you can get a little, you will soon be getting it all.

I'm going out on a limb here with a thought that is my own, not something authoritative. Expressing with 2 hands, pushing back toward the tail is a common method. I think there are people here who have used that method long term and kept their pets healthy. That is the method that the ER vet used with my dog about a week after her injury and produced a flood.

Me personally, being maybe a bit of a control freak or a bit of a perfectionist, it is not my favorite method (at least for a small dog) because I do not see how you can tell when the dog is empty. People assume the bladder is empty after they express-rest-express a few times and don't get any more out, so the dog must be done. That routine must work, because like I said there have been a lot of people expressing here, most of them 2-handed, some of them long term, and nearly all of those dogs did well. There have been a few with repeated UTIs, but they were a small minority. Hopefully you won't be expressing long term, it's too soon to tell yet.

I expressed my dog (in the video) for over 8.5 years. I always knew if she was empty because when you encircle the bladder and squeeze it empty, it's kind of like crushing a pair of nitrile gloves in your hand. You know when you have them crushed all the way. The bladder is a similar feeling. You have 360° feedback in your hand. Once it is expressed "down to a nub" you know it's empty.

I saw a recent study about residual volume of urine in the bladders of T3-L3 dogs that were manually expressed, and was very surprised at how much it was. There is always going to be a little residual volume, even in a dog that is not incontinent. The statistics in that study were kind of shocking, where nearly half the urine was left in the dogs by experienced vet techs. The problem with the study was, it did not compare methods of expressing or say how many vet techs were involved. One thing it says is:
However, a substantial number of dogs had marked variation in residual urine volume following manual bladder expression during the study
Gosh, what does that tell you? :shock:

I know for a fact that the way I expressed (as in the video) did not leave the amount of urine reported in the study.

We had someone with a medium sized male dog who was having difficulty trying to determine if she was getting her dog empty. She had trouble with expressing and was catheterizing. He was on prophylactic antibiotic cover for quite a while. Since her dog was male, she could catheterize after expressing. She ended up measuring his output so she knew what it should be, and was finally able to stop catheterizing and only express. I've always admired the way she went about it. If she had had a small enough dog and could manage one-handed, she wouldn't have had to do all that, but what she did was brilliant and it worked.

Anyway, as I think you've already read, expressing completely helps prevent UTIs. It also helps prevent stones and crystals by eliminating "sludge" and because some types of stones in dogs are started by chronic infection.

I'm sure it took me at least a month to halfway know what I was doing. You have been doing better than that since the beginning. You'll get it to your satisfaction soon.

I do also want to say, what you are going through is not just a matter of a learning curve. I had a much (infinitely) harder time expressing my dog after she had surgery. When she was found, she was not spayed. Over a year later, I had her spayed and I had great difficulty expressing her. The vet had put the incision well up toward the ribs, so it was not in the way. The problem was, she was so tense with pain and the hospital experience, I couldn't get her expressed even though I'd been doing it for over a year and already knew how. So right now you are dealing with a post-surgical dog. Bless her heart, she has an incision on her back and a sore spot on her chest, not to mention some frayed nerves that were resulting in colitis apparently, and if you are getting your little patient expressed at all, you deserve a medal, you just probably don't realize it. I ended up having to take my dog to the vet after not being able to get her fully emptied for 28 hours (he couldn't get it either), and I had already expressed her successfully 4x/day for 15 months. What is that, 1800 times? So you're doing good!
:trophy:
frenchiepup
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by frenchiepup »

She did come home with an e-collar, but I took it off. She hasn’t even touched the bandage once, I don’t think it will be a problem. But I’ve been keeping an eye on it.

Thanks for the words of encouragement! I do think I needed some more wind in my sails, much appreciated. This afternoon was my first completely failed attempt to get urine. I’m guessing (hoping) she’s just empty. She did drink some water this morning. I will try again tonight after dinner - if I can’t get any before bed I’ll call the vet tomorrow.

C
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by CarolC »

One possibility that might help is to ask the vet about a course of preventive antibiotics for her, so you don't have to stress so much if expressing is inconsistent right now. (Know you don't want to upset her GI tract, it's just a thought.)

Possibly she's not drinking as much while mildly sedated. Possibly she's not relaxing as well for you. Honestly, if she stands on her front feet while you express, and her burn stretches or the bandage pulls, she'll probably feel it and she may tighten her abdomen or carry tension in her whole body. I can't blame her if that's the case. Depending on how she is feeling at any given minute, she may be harder or easier to express.
https://handicappedpet.net/helppets/viewtopic.php?f=5&t=10282&p=51703#p51703 wrote:
pmilner wrote:Sometimes your doxie will tense up his stomach muscles, wait til he relaxes so you can feel for the bladder.
I have found that deeply kneading the abdomen by large handfuls with quite a bit of pressure causes my dog to relax a rigid abdomen fairly quickly. In her case I don't think tensing is intentional, she is paralyzed at mid-back.
Neck and shoulder rubs are good, too! :)
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by frenchiepup »

That's a good point concerning the wound and being tense. I got a little bit out at 6pm last night, then couldn't get anything just before bed, then got up at 4am and got a bunch out. So it's weird. Possibly she's just less full than I think she is, but I imagine there is some amount of tensing/tightening going on.

We're going to the primary vet today at 2:30. Hopefully we can really hash it out about the bladder, as the tutorials at the hospital where she had the surgery were always really quick. Maybe they will suggest prazosin or the drug you mentioned. Maybe an antibiotic, too. We'll see.

I'll be at work again starting tomorrow and won't be able to take time off for a little while. Hopefully better days are coming???
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by critters »

They can definitely help OR hinder the process, so maybe there's more of the former when she's been asleep? It's possible, too, to have a spastic bladder that may lessen when she's sleepy.
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

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Better days are certainly coming. You've had a couple of unsual complications, but fortunately you are getting through them. I've been remembering Lucy years ago who had a 65-lb dog that had a complication from surgery. Her dog was hit by a car. Broken leg, broken pelvis, and her intestines ruptured through her abdomen. The emergency vet who fixed the intestines accidentally sewed her urethra together, damaging it, which was discovered by the second vet who was going to pin the fractures, so she had to have another surgery to revise the first surgery. They sent her home with a catheter and 3 suture areas crisscrosing her whole abdomen, after which she pulled out her catheter, and then she had to be expressed. :shock: They managed, but I can only imagine what they went through.

I think things will calm down for you soon, too. You've treated diarrhea (now gone), a burn (being treated, will take time but getting better) and then the disk surgery, which normally would have been all you had to think about. In addition you are travelling back and forth between CT and NYC at a time when you are starting school, with a schedule that makes it hard to be home for lunch, and probably also trying to be careful about Covid. Not to mention that you probably "had a life" before all this, which must be kind of on hold for now. The things we do for our pets! There is no minimizing the fact that you are investing a lot of energy, and anyone who hasn't done it really can't appreciate what it's like, but it's going to pay off when you both have a good life again on the other side. :)

If you can screen out the surrounding static, you can see you actually have a good handle on things, only because you have focussed and addressed each issue as it has come up. The constant laser focus, analysis, and solving is demanding, and not for someone who is slow on their feet. She is lucky she has someone who can do all this. Hopefully things will begin to settle down and you can both catch your breath and progress on through the rest of this in a more normal fashion. There hasn't even been much time or mindspace to think about the neurological side of things while you wait for the nerves to heal, but they have been healing a little bit more every day in the background where you can't see it, the whole time the rest of this has been going on. Hope it's a good appointment this afternoon.
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by frenchiepup »

That does help put things in perspective Carol. I try not to think too much about re-homing (or worse), but in moments of doubt, the thought is there. But you're right - I'm in the worst of it right now, so best not let that color my thinking *too* much.

The vet thought we were totally fine. We did another demo and I explained how I felt sometimes it was tight or i couldn't get anything out, but from doing it there the tech (an old pro) said that she thought as long as I found the bladder, I was good. They said it's possible she had very little in her when I tried last night. I wasn't so sure, but they helped me kind of feel what an "empty" bladder feels like, and said that as long as I could sort of find that I probably didn't need to worry too much if I couldn't get much out. At least, for the beginning weeks. Like you said, the vet told me that getting *any* urine out right now was a good sign for how I'm doing. I'm still nervous, but they didn't want to start any meds yet. So if anything, the visit to the vet was more of an ego boost.

Now I need to get her drinking on her own. Right now she's very picky and will only take it from one of these. We have a fountain thing arriving tomorrow; it's multi-tiered so hopefully that will help with bending over vs. not. She's always been quite afraid of bowls, so this adds insult to injury!
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by CarolC »

Interesting. A travel bowl that fits in a cup holder. It sure looks sharp. I wonder what it is about it that she prefers. Hopefully she likes the fountain just as well.

They make special slanted bowls for flat-faced dogs like pugs and Boston terriers and bulldogs. The only reason I know is because I was looking for a slanted bowl for my new little tetraplegic dog who will not drink water. He seems to have a water swallowing problem. Anyway that was the first I heard of special bowls for certain breeds. I guess bowl problems with frenchies is "a thing". :D
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by frenchiepup »

Well, we're definitely in a better routine, and things have gotten a bit easier. Expression is mostly no problem (one time her dog "walker" came to express her and saw some cloudy pee that smelled funky, which I naturally freaked out about, but it's been totally fine for 3-4 days after) and her poops remain good. All good there!

Still on bed rest, I'm guessing 3 more weeks. We're at the 3 weeks from the surgery right now. I'm excited to get her some wheels, and a scoot bag and all that. I think she'll really like moving about - I think her biggest frustration lately has been continuing to be on bed rest.

She got her chest wound redressed yesterday. It looks good, so they told me, but they did put her on a new antibiotic for it because the last one there was resistance against. The new one also happens to be used for UTIs, so I think that will make me calm down a bit more in the coming weeks.

I'm very hopeful that our next drive out to CT - either Thursday or next weekend - will be our last. Then we'll maybe start to get our lives back a bit!
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Re: Frenchie w/ Stage V IVDD, Post-Surgery

Post by CarolC »

That sounds really good. :) A little more sanity and normalcy would be a welcome thing. You do develop a new normal, and it becomes very streamlined.

I'm sure it feels a lot better knowing she's on some kind of antibiotic that also works for urinary. When I was learning to express, I thought I was doing it right but my dog got a urinary tract infection about a week or so after surgery because I wasn't getting it all. I was glad when they put her on antibiotics for 2 weeks because it gave me more time to learn to express. I remember the relief I felt.

In the event that your dog ever does get a UTI at some point, they tend to clear up pretty readily with standard antibiotics like amoxicillin. Occasionally someone will have a dog with something that doesn't respond and it has to be cultured and another antibiotic will be prescribed, but that's unusual.

A few times over the years I have taken a urine specimen in to the vet to be checked. I use a clear Pyrex brownie pan (3-cup pan) that can be washed with boiling water to express into, and pour it into a brand new sealable plastic container, mark the collection time on the lid with magic marker or masking tape, and take it straight in and they check it right away. If you're going to do that, it's best to call ahead and be sure there will be someone available to check it right away, because if it's left to sit for 30 minutes after collection it can start to form crystals (when your dog doesn't have crystals) and could give a false positive on crystals. That's why marking the collection time and taking it straight in is better.

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https://www.amazon.com/Pyrex-Simply-Sto ... B004GHF7GK
https://www.walmart.com/ip/Pyrex-Simply ... p/53660236

I keep a pack of Glad Ware mini round containers on hand for this purpose. (Walmart, grocery store) They hold a half cup. If you want to be really spiffy, it's nice to have a paper lunch bag to put it in, to take it to the vet, so you aren't handing them a cup of urine where you know you wiped it clean but they don't know you wiped it clean, if you see what I mean. Just saves awkwardness.

Glad_mini_round.jpg
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Glad the skin is healing. Interesting that they had to change antibiotics but it is healing anyway. :? It's probably no big deal, but if it was me, I'd be left scratching my head like, "Hmm, that first antibiotic didn't work and at the end of a week they changed it. How do I know if this one is working?" But you will be monitoring her.

If you ever think you might need it, there is a veterinary drugs reference that you can find online new or used. It's kind of expensive new but you can find a serviceable not-the-latest edition on ebay or a used books site for a more reasonable price. Plumb's Veterinary Drug Handbook.

https://plumbs.com/

https://www.abebooks.com/servlet/Search ... ndbook&kn=

I've been doing something for Dolly when she had to be crated this time. She has been partially paralyzed since birth (birth defect in lumbar area) and has been having some neck pain. She's doing 8 weeks. I ended up cracking the window over her crate, not because I was smart and thought it would remind her of outdoor smells, but because she's being crated without her diaper and she dribbles 24/7 so there is a little odor almost as soon as I give her fresh bedding.

In the morning when it's cool I open it about a foot and it stays that way till 11 or 12, and the rest of the day when it's hot, and at night, I crack it an inch. It's ground floor and security is an issue and we have exterior bars but they're not great, so I reinstalled the interior bars that were there before (window now has double bars) and can crack it without worrying. I didn't realize it would make such a difference to her, but I see her lying facing the window, and it's pleasant when I go in there to change her bed and smell the fresh air. Such a little thing, wish I'd thought of it the first week. :)

I'm not sure which company you are looking at for scoot bags. I have only bought one, which was from Walkin' Pets. You were supposed to measure by length and I thought I had the right size, but it was way-way-way too tight in the waist. Dolly's waist is nice and trim, but that bag might have fit a cat or a ferret. If I had to do it again, I'd go big, however that was 5 years ago and they may have changed them since then.

Glad to hear the good news!
:thankyou:
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