Mindi - Progress

Our surviving Shih Tzu, Mindi, had a ruptured disk and was operated on at LSU on Friday, March 27, 2009. As chronicled on A Jaded View, we have have had a tough time of things since then, particularly the loss of our other Shih Tzu, Molli.

Mindi is now in her 28th day post-op and she is finally showing progress. It was acceptable to let her stay in one spot and gets lots of rest; that was ordered by the surgeon for the first four weeks post-op.

But, with the four week milestone looming, I was pretty discouraged yesterday. She has been an underachiever at the LSU rehab center, and when she was home, all she wanted to do is sleep. She has always been rather a passive and laid back sort of dog but this was ridiculous. I didn't know if she was depressed, in pain, or what, but she didn't want to do anything, including the passive range of motion, standing and stand-sit.

By yesterday afternoon, I was feeling overwhelmed at the prospect of being a private duty nurse to the paralyzed dog. Finally, I started thinking like a nurse. I recall having patients who became disabled and they didn't want to relearn the skills that would greatly advance their ability to be independent in their activities of daily living. Sometimes it is just too daunting for a weak, frail, and, possibly, depressed person. In those cases, motivation is a huge factor... but something a nurse can go only so far to provide. The patient has to want to progress.

I was tired yesterday and I started talking to Mindi. I told her this was not working for me. At 4 weeks post-op, I thought she was less interested in doing her exercises than she was even when she first came home. Changes had to be made.

First, Miss Mindi had to get her butt outside more and get interested in the environment she had enjoyed for the six years of her life. YES, she might miss Molli and she might be depressed, but she has to move on. We had been carrying her to the yard and we held her up with the sling so she could do her business. Otherwise, she would lay quietly in the grass - and that was OK for 4 weeks because that is what we were supposed to do.

Inside the house, we have two kennels for her, water bowels all over, and we were taking her to the water or taking the water to her. Same with the food. So I asked myself: "If we are anticipating her every need and she does not have to move, why would she want to move?" I decided that we were enabling her to do nothing but sleep and be lazy.

Incidentally, she weighed 23 lbs. 7 oz. at her highest, just before surgery, and I know she is only about 20 pounds now. We have had no trouble at all getting her to eat the "Lite" Science Dog Food.

So, feeling somewhat desperate yesterday, I took Mindi into the back yard and put her in the grass. I watered the flowers and she didn't move. In her earlier life, she would have barked at the dog next door, etc. - Nothing. I needed to inspire her to move, so I got a tiny piece of a Pupperoni and put it about 3 feet away from her on a towel. I let her smell it and then walked away. Within 2 minutes, she had managed to get herself over to it and eat it. This is the first time in four weeks that she moved that far. Next, I put a tiny piece about 6 feet away and had the same result.

The point being that she was motivated and she figured it out.

We don't know how much motor function will return. At this point, I believe she will walk - but even if she did not, it is my responsibility, just as it was when I was a nurse, to help her do the best she can with what she has. If she never walks, she can still get around the house and she can certainly find her food and water.

Once I saw that she could move herself significant distances, I knew that she was doing very well at 4 weeks post-op. Her right hind leg is much weaker than the left but when she wanted to get that Pupperoni, she managed - and that will strengthen her.

But there is more to the story. When my daughter came home, I asked her to stand in the doorway, rather than walking directly over to Mindi. As soon as Mindi saw her, she flew across the room (about 10 feet) to greet her. Again, her right leg is weak but her left leg was actually walking. - And this is the dog who had barely moved for weeks. Obviously, we were always going to her and she had no need to move toward us.

Not done yet.

Finally, we took her outside last night and instead of putting the towel under her as a sling to hold her backside up, we just let her figure it out. AND SHE DID. She sort of hobbled along in a small area and then she managed to hoist herself up enough to make a poo. And we presume she also urinated.

Today she is at LSU for PT and that should help to further strengthen her. Of course, we are extremely happy with the progress she made yesterday. It was simply a matter of motivating her to move - and then once she saw that she could, she did more. She is not going all over the house yet but I expect that will come in the near future.

UPDATE MAY 13, 2009: Mindi went to rehab/PT at LSU for ten sessions that lasted through May 8. She really wasn't ready to swim or do the treadmill when she first started so we aren't sure what she did. On the 6th visit, while waiting for her to be picked up by the therapist, my husband noticed blood on the fur of her right shoulder. She had an abscess, related to a "puncture wound." This was probably from the attack on her by Molli at the time Mindi's disc was ruptured. She was started on an antibiotic and a culture revealed a staph infection. She went for 4 more more sessions and ONE time she walked on the bottom of the swimming pool. They apparently did other forms of rehab but we just don't know exactly what.

On Mindi's last day of rehab, she got a discharge report stating that she was doing very well, although still mildly to moderately ataxic, with mild proprioceptive deficits.

No doubt, Mindi is relieved to be able to stay home now. She cringes when my husband is getting ready for work because she fears he is going to pick her up and take her with him in the car. She only settles down after he is gone and closes the garage door.

At this time, Mindi is doing extremely well. Her injury was severe - and it was a good 72 hours from the time she sustained her injury until she had her surgery. She always retained her deep pain perception but she had lost her bladder and bowel function. I was worried that we had waited too long to have the surgery but it seems that she will recover, after all.

During the past week, Mindi has improved very rapidly. A week ago, she could stand and she could walk only a short distance before sitting down to rest. At times she did more if she was very excited, such as when someone came into the house, but, in general, she was not very strong. We still had to carry her from room to room, carry her outside, etc.

This week, Mindi is walking much more. She certainly does not have her pre-injury stamina but she is walking on runners all over the house. She also RUNS through the house when she is excited. Outside, she manages to walk and run in the grass, and that is not a flat surface. She is still slightly ataxic - and may always be - but she is very close to being back to normal.

Mindi has lost about 4-5 pounds of the 23# 7 oz she started out with. Her ideal weight is supposedly 15-17# so we are aiming for that. We have no problem at all with her, in terms of her diet. She is on the Science Lite and she seems to love it. - Well, there is one issue: The food is mostly roughage and she poos at least 4 times a day. We don't know if she will be on this LITE for the duration or if it will just be until she loses the weight.

I hope that these blogs about Mindi's ordeal will provide encouragement to others who are going through this experience. When I tried to find information about the post-op steps to recovery, I found very little online. The only site I found that made me feel hopeful in the dark days was this one: http://www.michvet.com/library/neurology_ivds_thoracolumbar.asp In it, under the the heading, Prognosis, it says:

"Following spinal surgery, it is common that the neurological status may be the same or somewhat worse than prior to surgery. This is caused by the myelogram and surgical manipulation of the spinal cord. In most cases this is a temporary set back and improves in a few days. Dogs that are paralyzed prior to surgery usually have a 3 to 6 week convalescent period before they can walk again. At this point they frequently are still unsteady on their hindlimbs. By 2 months after surgery most dogs are able to ambulate very well. Improvement in the strength of the hindlimbs can progress until the 6th to 9th month after surgery. In general about 95% of the dogs that have hemilaminectomy surgery will be able to walk again."

And Mindi is exactly on track.