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:

• Bladder expression
• Medications
• Incision care
• Exercise restrictions
• Physical rehabilitation and recheck appointments
• Wheelchairs and Assisted Devices

Bladder expression
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. 

Medications
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.

Incision care
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.
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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. 

Assisted Devices
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.

Wheelchairs
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