Neurological nursing care and information for pet owners with animals recovering from hemilaminectomy, dorsal laminectomy, ventral slot and spinal fractures.
Neurological recovery is difficult for patients, but it can be hard for caregivers as well. Neurology can be intimidating to learn about or understand, especially if it is concerning a loved one. Recoveries can be fast for some patients and torturously slow for others. Veterinary neurological patients can sometimes take many months to get better depending on their individual diagnosis and prognosis. The uncertainty of how much recovery will take place and how long it will take to get there is also a difficult reality for everyone involved. It takes a team approach to care for animals recovering from a neurologic insult and we want you to understand as much as possible so that you can also be part of that team. We are here to help and we do our best to clearly communicate your pet’s prognosis based on history and scientific evidence. In the below blog post we will address several topics that people commonly have questions about. If your pet is a Resurge patient and you have questions about them please contact our office anytime and we will be happy to help.
Topics covered in this post:
Following neurologic injury or surgery some patients may need their urinary bladder manually expressed. The nerves that allow normal urination may be inflamed or damaged, leading to the patient to be unable to urinate on their own. Urinary bladders can become overfilled, distended, and if left un-expressed can have irreversible effects on the patient’s ability to urinate on their own. Neurologic patients can also be prone to bladder infections. These can be uncomfortable and can sometimes lead to setbacks in recovery.
Bladder expression is not an easy task to master. Give yourself some time to learn how to do it and please contact your veterinarian if you are having problems.
Most patients will go home with several medications after surgery. Among other benefits, these medications are there to help prevent infection and/or decrease pain and muscle spasms. Pain and discomfort can delay recovery and medications should be given unless your pet seems to be having a problem with taking them. Your pet may be on several different kinds of medications all geared at the same goal. Some owners feel overwhelmed with the amount of meds, but they are all there for specific reasons. Please follow the directions on the pill bottles, and if there is any questions, these instructions will be reiterated on your pet’s surgical discharge summary inside the folder which is sent home at the time of discharge. Many recovering dogs feel great after surgery because we are treating their pain. For those who are sore and tender, this pain will subside shortly and most patients come off of medications at or around the 2-4 week postoperative date. Please watch the video below on how to give medications. It will give you some tips and tricks to keep your loved one out of pain and assist in keeping bad tasting medications from being spit out.
The most common places to have incisions from a veterinary neurological surgery are on the back over the spine and under the neck. Both of these areas are difficult for patients to lick, but regardless it is important to keep a close eye on them to make sure they are not able to get to their incision site. Licking can cause infection, and infection can lead to serious complications. If your pet had surgery at Resurge, then incisional care is minimal. You should NOT clean the area, you should NOT put topical medications on it, or really do anything to the incision site unless we have outlined it within your surgical discharge summary. Bathing should be avoided until 10-14 days postoperatively. If you feel like your pet’s incision looks bad an any way, please contact us and we will do our best to guide you to the best resolution.
Exercise Restrictions/ Confinement
Exercise restrictions and confinement are an imperative part of the recovery process. Most pet parents feel like this part of recovery is like locking their loved one in jail, but it is more like a human patient being put on bed rest. Your pet may feel great after surgery and they may want to go back to their normal routines very quickly. However, if your pet has had a hemilamenectomy or a ventral slot, then the normal protocol for keeping them inactive is for 4 weeks post surgery. This timeframe allows proper time for tissue healing. How they feel or act has nothing to do with tissue healing time, therefore please do not allow any more activity than is outlined in their surgical discharge summary.
Surgery discharge summaries generally state that patients can be brought outside to go to the bathroom for 5 minutes maximum, 3-4 times a day. When inside they should be confined to a crate or kennel. Large dogs can be put in an exercise pen. Confinement areas should not exceed a 4’X4’ area. Excessive walking can cause weakness and prolong the inflammatory process. This can make patients look like they are not progressing in the recovery process and in some cases cause serious complications. Some patients may have delayed reflexes and/or ataxia (drunk like walking). At times they may think they can do something such as jumping on or off the couch, but fail at it. Avoiding letting them attempt these movements or activities is important because any mishaps can cause severe setbacks in recovery and sometimes irreversible injury to the spinal cord.
Some animals may act like nothing has happened and are back to their normal selves very quickly. However, it is wise not to trust your dog, as they do not know what is best for themselves and they do not know when their tissues are healed. It will take at least 4 weeks for those tissues to completely heal after a hemilaminectomy or ventral slot. It will be at least 8 weeks of healing time for spinal fractures. Please reread your discharge summary and follow your doctor’s orders for the best results.
Physical Rehabilitation and Recheck Appointments
Patients that had neurological surgery here at Resurge are seen by the physical rehabilitation service at about 1 week post operatively. We have found that when we see patients this early we lessen the overall amount and costs of post-op rehabilitation and the outcomes tend to be much better. At this visit you will be seen by one of our therapists. They will go over any concerns or questions you may have and will create a plan for ongoing therapy, if needed. If you would like to learn more about your pet’s first session, please watch the below video.
Our surgeon will want to recheck your pet at 4 weeks post operatively before lifting the exercise restrictions. Please make sure you schedule this appointment at the time of surgical discharge from Resurge. If your pet is having abnormal problems with recovery, she will be glad to see them before that.
Hyperbaric Oxygen Treatments
Resurge Veterinary Surgical Specialists and Rehabilitation LLC, is the only place in the southern states to have a Hyperbaric Oxygen chamber and a certified veterinary hyperbaric oxygen technician. Hyperbaric oxygen can help bring nutrients to healing tissues. It is also very beneficial in reducing inflammation of nervous tissue. Inflammation of nervous tissues is generally the cause of pain and a lack of communication from the brain to the body. All our surgical patients receive one treatment after surgery, however if your pet is not making consistent improvements or cannot walk, then getting them back in for more treatments, sooner rather than later, can have profound positive impacts on recovery. If you would like to pursue more aggressive hyperbaric oxygen treatments, please be sure schedule a visit with one of our therapists or discuss it with the technician at the time of discharge.
Some patients are able to walk on their own, but easily slip on surfaces at home like wood or tile flooring. This is generally due to a lack or proprioception, or internal body awareness. Normally the patient’s feet would send a signal to their brain telling them they are slipping, however in some cases that communication may be delayed, so the patient’s brain doesn’t know the foot is slipping before it’s too late. Some people place runner rugs along the paths that their pet generally walks. This tends to help a lot all by itself. Other patients may benefit from having the hair from between their toes trimmed. This allows more of their pad to come in contact with the ground, leading to more traction. Toe Grips can also help by adding more traction for your pet. Toe Grips are small pieces of latex tubing that slide over the dogs toe nail. There is a small “grip zone” that comes into contact with the ground that provides a surprisingly large amount of traction for some patients.
Patients suffering from conscious proprioception deficits tend to “knuckle,” or not flip their foot over fast enough to place it on the ground correctly. Most patients don't realize they are placing their foot on the ground incorrectly. Some patients with this type of deficit may benefit from kinesiology taping techniques. K-tape can assist in dorsi-flexion, facilitating a more normal swing phase of gait. It mechanically helps place the foot in a more normal way and may help pattern more normal movement over time. Check out the video below and see how it helped Colton.
When recoveries are longer than we’d like and/or we have not made much functional recovery in a timely manner, then patients sometimes need assisted devices or products to help them with daily living. Dog wheelchairs can help improve quality of life and allow the patient to feel more independent. It can also assist in building strength in both the front and back legs if properly used and adjusted. However they do not replace the animals limbs.
Written by Robert Porter CCRP
Many of our pet parents come in for their complementary 2 week recheck/ rehabilitation evaluation and are filled with anxiety about their dog being afraid of water. They are apprehensive that their dog will not take to the underwater treadmill due to fear of water or negative past experiences with water. This is a real fear and we do our best ease both the human and animal minds before we do any therapy. Some dogs don't like baths and may have had a negative experience with swimming in a pool or body of water. If this is the case, please let our therapists know so that we can help cater their training and reduce overall stress during this visit. We want them to leave feeling good, not scared.
Are Underwater Treadmills the same as swimming in a pool?
The short answer is no. Underwater treadmills are very different than baths, pools, or bodies of water, and walking in water is very different than swimming. Understanding these differences help us train underwater treadmill exercise and not go down the the same path as their previous “bad” experiences. One of the main differences is that the water is pumped into the treadmill tank once the patient is walked into it verses the dog being put into a body of water. This is generally not very scary and since most patients don't have any other experience like it, they do very well and don't really know that they should be scared. Swimming is also scary to dogs because they can’t touch the ground. This creates a panic and they likely feel threatened, which creates a fight or flight reaction in self preservation mode. That is definitely not want we want our patients to feel, so their feet are always firmly planted on the ground during the entirety of the underwater treadmill experience.
What should I expect during my first rehabilitation visit?
At your first visit, one of our therapists will bring you and your dog into one of the therapy rooms and discuss how your dog has been doing at home since surgical discharge. This is generally done at 1 to 2 weeks post operatively. This visit gives you a chance to voice any concerns or problems you may have and it give us the opportunity to see how your dog is doing and take those concerns into consideration. If your dog is food motivated, then our therapist may try and play some basic games that allow us to evaluate them better from a functional standpoint. Some dogs that are generally food motivated may be nervous and may not eat during this session. That’s ok, they have a right to be nervous and forcing the issue doesn’t usually help, so we avoid any forced activities. In other words, you can’t force a dog to not be nervous, so we adapt and overcome. They need a good, positive experiences to learn that they are safe. If ongoing therapy is needed, most learn that rehab can be fun and rewarding over time.
Once concerns, questions, and the initial evaluation is done, we then have their sutures or staples removed and train them to walk in the underwater treadmill. This generally only takes 1 minute because all we really need our patients to do the first visit is to walk forward. If we keep that first session nice and short, patients tend to leave without feeling trapped in the treadmill and if ongoing therapy is needed, it is very easy to extend times and increase speeds to meet the patient’s needs. If we ask for too much of them too fast, then we can ruin the therapy training session and ongoing therapy will become increasingly more difficult. All of our therapists train our patients the same way with little changes to fit individual personalities. About 90-95% of our patients do very well at that first session and easily walk forward toward the door they where they were led in. If they do not quite get it at first, that’s alright, and most do understand by the second time. Our therapists have trained thousands of dogs to walk in underwater treadmills, on land treadmills and have also trained many other exercises over the years. This doesn’t mean they know everything, but it does give them a lot of insight and understanding on dog behaviors, especially in the clinical rehabilitation setting.
If you have any questions about your first visit, please let us know and we will always do our best to explain everything we can to ensure comfortability and confidence with rehabilitation moving forward.
By Robert Porter CCRP
Some hospitals do rounds for patients, but here at Resurge, we do rounds a little differently. We do what we call Patient Parades. We started out with our very first episode of Patient Parades showing Dr. Dena Lodato rounding with her surgery patients to evaluate their post-surgical conditions. She meticulously checks each patient’s incision, appearance, pain levels, lung and heart sounds, as well as their spirit. Surgery can be stressful and scary for patients, owners, and veterinary staff. We make every attempt to keep the atmosphere upbeat, fun, and as stress-free as possible. Keeping our patients happy and comfortable is a top priority, especially as they are away from home and their loved ones. During episode two, we show our comedic side and how we keep things lively and light. Episode three shows how body language and subconscious cues affects dogs, who are extremely keen in picking up on stress, anxiety, or distress from owners and staff alike. We try to keep this in mind during our day-to-day interactions and cultivate a fun and healthy environment for patients and employees. A happy staff makes for happy patients and happy clients. In episode four we focus on laughter and smiles. Laughing helps to lessen anxiety in stressful situations and smiles are most definitely contagious. We spread laughter and cheer all day every day to everyone who comes into our hospital. Keeping each other laughing is one of the ways that we show our love and care.
Getting to share these moments with our clients through episodes of patient parades is just one opportunity we just can’t pass up. We all truly enjoy making others smile and sharing the joy of helping our patients. We want people to see that we love what we do, we get attached to our patients, and we are definitely attached to each other. We want others to enjoy seeing a small glimpse of what we enjoy so much. Life at a veterinary hospital is incredibly hard. It’s filled with late nights, weekends, emergencies, unforeseen problems, and sometimes tears. One of our gifts is the gift of creativity. Getting creative to help patients and coworkers is one way that we overcome the challenges of Veterinary Medicine. When stress stacks up, it can be easy to fall into a negative mindset. But negative mindsets do not perpetuate positive outcomes. So, we give our all to stay positive, motivated, happy, and silly. We let our unique and quirky personalities show to keep the environment upbeat and fun. We are very serious about the level of care we give to our patients, our communication with clients, and providing surgical solutions and rehabilitation to our veterinary community. During difficult times, it’s important to laugh, and Dr. Dena Lodato knows how to do just that. She is by far one of the most humble surgeons we have met. Her empathy and compassion are unmatched, and she inspires our staff to aim for nothing short of success. As episode five shows, our staff is never scared to talk with Dr. Dena or approach her with a problem. She always gives 100% to every situation in which she is needed. We hope through our series of Patient Parades that our love of animals and laughter lead to successful recoveries and happy, healthy patients.
Written by Brittany Murphy and Robert Porter
I headed out to a Dock Diving competition and to teach some injury prevention classes last week. I was able to stay at a friend’s house near a lake and fit in some family vacation fun in the process. After watching and filming dogs dock diving, and boring my kids, I thought I would also give handling a dog and jumping off of a dock a try. Being the handler could help me see through the eyes of the other trainers and bring me closer to what the sport is about. I had a little experience sending my own dogs out into my pond, but that was about the extent of it. During this trip I also planned on jumping off a dock myself at my friend’s lake house on my BMX bike. That probably sounds crazy to most, but I was hoping it would help me empathize with the dock diving canine athlete on some level. It also sounded super fun to me. But in all seriousness, trying to empathize with patients and their humans is a big thing in my world. It can have profound impacts on patent care, and the understanding of pathology, prognosis, and recovery process with the veterinary patients’ humans.
Once I got to the Dock Diving event, I borrowed a friends dock diving dog, named Risk. I started up the maze of fenced ramps and gates, with a super excited Golden Retriever on the end of the leash who was eagerly anticipating his launch into the pool. I then made it to the end of the dock overlooking the pool. I asked “Risk” to sit and stay, then walked to the end of the dock that was two feet above the water. All of a sudden my thoughts were filled with details like, how I should throw, which side of the dog should I be on, is Risk going to stay and wait for me to get to the end of the dock? Is Risk safe with me handling him? Is everyone looking at me? Are they laughing? Am I doing this right? I took a deep breath, gave Risk his release word, watched him charge toward the end of the dock and I did my best to throw out his bumper (dog toy) facilitating a world record jump. Instead I got him to 12 feet. He generally jumps 16-18 feet so there was a lot of room for improvement. I repeated the process several more times with minimal improvements. Then, our turn was over and I got lost trying to exit through the maze of gates. Me getting lost on my way out was my oldest son’s favorite part.
Now on to empathizing with the canine athlete and for some BMX fun. My kids and I drove to my friend’s house from the Dock Diving event. I then put together a small BMX style jump and placed it on the end of the dock. I strapped a life vest on an old bike of mine and then sent it into the lake, full speed, about 10 times in a row before becoming completely exhausted. It was fun, it hurt, and I would always do it again.
Before I tell you what I learned, here’s a little back story. I have ridden some form of BMX since I was a kid. I am no where near a professional athlete, I battle old injuries on the daily, but each day I live, I continue to have a goal of riding everyday of my life. Ten to eleven years ago, I put the BMX bike away after sustaining a compressive fracture to one of my lumbar vertebrae and having several doctors tell me to change my lifestyle and sport. At that point I completely stopped riding, but the thought of it never left my mind. I had tried to replace my daily BMX exercise with other sports or hobbies but they never were as enjoyable, creative, or inspirational as the times I spent on my bike. I grew increasingly more depressed and just felt lost without my sport. I started physical therapy, worked hard, exercised daily, and started riding again several years after my injury. I’ve spent the last four to five years building dirt jumps in my backyard, relearning old skills, conditioning my body and mind, and I get to engage my old goal of riding my bike each day.
I say all this because many of my clients ask me if they should stop their dog from competing after an injury. I find this question very difficult in the aspect of ethical physical protection of an animal in someone’s care and also in the animal’s mental and physical wellbeing. Many people and dogs enjoy competition on numerous levels. Competition can help motivate, improve performance, and provide a goal to work toward. There’s also a social aspect of competition as well as a human-animal bond that can be damaged. If the competition does not exist, the motivation tends to decline, people within the community suffer and the canine athlete loses their sport and possibly their purpose in the human world. This decline can lead to depression for both the animal and the trainer. Many people tell me, “It’s okay, I don't have to compete them to have fun with them,” but dogs tend to know the difference, even when you think they don't.
There is not an easy answer for an animal athlete’s return to sport or not. Every case should be looked at individually and that decision should be based on all the above details and more. Details should be explored thoroughly before making a decision. The best advice I could give anyone is to do their best at keeping their four-legged athlete in shape. Keeping up with current training techniques and always working on becoming a better handler is top on the list. Good nutrition and a healthy body weight is an easy thing to do for most. Finally, conditioning exercises that are targeted at injury prevention should also be preformed on a regular basis. Many of the exercises I do within my conditioning program are also investigative and allow trainers to spot abnormalities before they become truly “career ending”.
We would love to hear about your experiences in how or why you have kept your dog in sports or taken them out due to injury. I think we all need to continue to look for solutions to continue to help our canine athletes live long and purposeful lives filled with joy and lots of fun.
Written By Robert Porter
Robert Porter, CCRP has been teaching his canine conditioning program all over the world, for close to ten years. The same positive approach to therapeutic exercise seen in his workshops is incorporated into post-operative recovery regimens at Resurge Veterinary Surgical Specialists and Rehabilitation. Each rehab plan is custom curated to every individual patient’s ability, needs, and goals. Robby's exercise and training system serves surgical patients just as well as agility, working, and sporting canines to provide an enriching approach to exercise, strengthening, conditioning, and recovery. In this video, Robby’s students can be seen utilizing his positivity-packed methods of canine conditioning and fitness to bring a sense of joy and fulfillment to both dogs and owners alike.
#resurgerehab #canineconditioning #caninerehab #positivereinforment #lowstresshandling #makeexercisefun #itspossible
It’s difficult to imagine loosing your ability to move, to walk, to drink, to eat or go to the bathroom by yourself. I can only guess what an emotionally frustrating roller coaster of not knowing why, when or if you may get control of your body back could feel like. Louie suddenly lost everything. He didn’t know why, when or if he was going to get better. On top of having a life changing spinal cord injury, Louie is also an insulin dependent diabetic. None of this stopped Louie. He never came into therapy and felt sorry for himself. He never refused a challenge and he never gave up. He looked past fear, past failure, embraced the process and knew exactly what he wanted… chicken:)
I hope Louie can be an inspiration for dog parents and veterinary professionals to push through the challenging moments and stay focused on creating New Movement, a New Life and a New Beginning for their loved ones and patients.
#ANNPE #typeIIIdisc #veterinaryrehab #louiethegreat #newmovement #newlife #newbeginning #spinalcordinjury #nevergiveup #cantslowdown #runbeforeyoucanwalk #veterinaryrehab #underwatertreadmill #LASERtherapy #inspiration
Max came in 2 weeks ago unable to sit up or do anything by himself. He was in a lot of pain and instead of moving his head to look around his world, he could only move his eyes. Dr. Dena Lodato MS, DVM, ACVS, CCRP took him to surgery and removed the compressive herniated disc that was pushing on his spinal cord. He was then put into our rehab program where he learned new movement, started a new life and is now ready for a new beginning. Thank you for never giving up, Max. We can’t wait to see you improve even more.
Gobbles was born with a rare condition called cerebellar hypoplasia. Basically, the part of his brain that helps regulate movement and impulse never developed correctly. Gobbles has been coming to therapy for the last month and has made some good progress so far. There was a time when he couldn’t walk well and would even just drag himself around. We all just love Gobbles. He always gets everyone dancing and sharing the purple green and gold love. He truly brings the spirit of carnival everywhere he goes. Thank you for brightening everyone’s day Gobbles. You’re the best!
Barley has a condition called Degenerative Myelopathy or DM for short. DM causes a slow loss of function to the rear limbs and other parts of the body as the disease progresses. Unfortunately, there is no cure. However, therapeutic exercise can help slow the progression of the disease. It is a sad diagnosis but a positive point is that it’s a non-painful disease. Our therapists, Melissa O’Brien RVT, CCRP and Robby Porter CCRP, have really enjoyed seeing him the last few weeks and will be rechecking him on a regular basis. Barley's hair is especially magnificent and his personality is too. Great working with you Barely, stay strong!
Marley is going home to start a new beginning. No more pain in her knee, no more rehab (even though that part is fun), no more meds, and soon no more rest. She has been here at Resurge since we opened in January and was the first TPLO performed here. Marley's owners live in Memphis,TN which is a pretty far drive… This made rehab and aftercare pretty difficult but we all wanted Marley to have a new life. We decided that as long as Marley wasn’t very stressed about staying with us she would have surgery with Dr Lodato, then start rehab with Melissa O’Brien RVT, CCRP and Robby Porter CCRP. We would then send Marley home when we thought she was ready. At 4 weeks post-op Marley is looking great! She still has a little R and R left until her bone completely heals but she is well on her way. We will all miss you, A LOT Marley!!!! Congratulations on your new beginning!