Need help with post-op back/neck dog

[Guest guest]

I am seeing Zac for the first time today, to start rehab. He had back and neck

surgery with us back in March. He is a 14 year old, MN, Maltese that weighs 10#.

He just started walking within the past two weeks on three legs. The issue now

is the left front leg. It is straight and pulled to towards the back. The elbow

is stiff and extremely difficult to move at all. When I place him in the UWTM he

puts all four legs stiff to the point that I am unable to move them. I'm at a

loss as to what to do with him. Any and all suggestions are welcome. The owner

is happy with his progress but wants him to be able to move more and be more

independent. Followed is the surgical report.

I will also create an album under the photos link of his leg.

History (11:16 am A. Moss, DVM./HR)

Referred here for evaluation and possible myelogram. He has had " disc issues "

on and off since last summer.

Physical Examination (11:18 am A. Moss, DVM./HR)

Temperature: 100.6, Weight: 4.577 kg, 10.07 lb, 0.28 m2, Appearance: Alert,

Mucous Membranes: pink, Capillary Refill Time: <2 sec. The heart and lungs were

ausculted and sounded normal. Primary Problem: Ataxic with CP deficits in both

the forelimbs and the hindlimbs. The hindlimbs are worse. No further

abnormalities found.

Radiographic Findings (11:24 am A. Moss, DVM./HR)

A myelogram reveals ventral extradural masses at C5-6 and C6-7 in the cervical

spine. There is ventral spondylosis and end plate sclerosis at L2-3. The cord is

also compressed at L2-3 indicating bone spurs within the spinal canal causing

compression.

Post-op radiographs reveal good implant placement and alignment of the bony

segments.

Final Diagnosis (11:25 am A. Moss, DVM./HR)

Intervertebral disc extrusions at C5-6 and C6-7 treated surgically with a

ventral slot and with prophylactic disc fenestrations in the rest of the

cervical spine. Bone spurs within the spinal canal at L2-3 causing cord

compression were treated via stabilization with pins and PMMA bone cement.

Anesthesia (11:30 am A. Moss, DVM./HR)

IV catheter placed

Pre-med: Atropine (0.5 mg-ml) 0.5 mls. IM, Acepromazine (10mg-ml) 0.01 mls.

SQ, Morphine (15 mg-ml) 0.15 mls. SQ,

Induction: Propofol (10 mg-ml) 1 mls. IV, Maintenance: Isoflurane,

Intra-op Medications: Cefazolin (100 mg-ml) 1 mls. IV,

Intra-op fluids: CRI (Morphine, Lidocaine, Ketamine) in LRS 122 mls. IV ,

Post-op Pain Medication: Acepromazine (10mg-ml) 0.01 mls. SQ, Morphine (15

mg-ml) 0.15 mls. SQ, Recovery: Uneventful.

Surgical Procedure (11:33 am A. Moss, DVM./HR)

A ventral approach was made to the cervical spine. A ventral slot was performed

at C5-6 and C6-7 and a moderate amount of disc material was recovered.

Prophylactic disc fenestrations were performed at C2-3 through C7-T1. Closure

was routine with 2-0 PDS in the fascia and the subcutaneous tissue. Stainless

steel staples were used in the skin.

A dorsal approach was made to the T-L spine and the 2-3 interspace was

identified. All soft tissues were debrided from the dorsal aspect of L2 and L3.

Pins were placed in each of the vertebra at a 45 degree angle in a criss-cross

pattern (2 per vertebra). Then a third threaded pin was placed side-to-side

through the base of the dorsal spinous process. The pins on each side were

cemented together using PMMA bone cement containing gentamicin. The cement was

flushed with cold IV fluids to prevent overheating. Closure was routine with 2-0

PDS in the fascia and the subcutaneous tissue. Stainless steel staples were used

in the skin.

Medications (11:42 am A. Moss, DVM./HR)

***Tramadol (Ultram) 50mg tab #7

Rx: Gave 1/4 tablet every 12 hours while in the hospital.

***Clavamox tabs 125mg #27

Rx: Gave 1 tablet every 12 hours while in the hospital.

Discharge Instructions (11:42 am A. Moss, DVM./HR)

***Keep Zac confined to a clean, dry no greater than 3 foot X 3 foot area for

the next 14 days.

***The sutures have already been removed. Check the incision daily for redness,

swelling or discharge. Please call if any of these occur.

***No more collars. Please get him a harness!

***You can carry him out to the bathroom on a leash, but no stairs, no

furniture, no running, jumping, playing, or vigorous activity for the entire

time of his confinement.

***Be sure Zac is urinating regularly. Have him rechecked if the urine develops

a foul odor. Urinary tract infections commonly occur in patients with spinal

disease.

***Make sure he is eating and drinking well.

***Plenty of padding should be provided in his bed. The bedding should be kept

clean and dry to prevent bedsores. Recheck here in 1 week and again in 2 weeks.

***Physical therapy: Please follow the rehabilitation instruction sheet.

***Please call if you have any problems or questions.

Monday, April 02, 2012

Moss, DVM/MM)

I saw Zac today for a recheck.

He is doing about the same.

Rx: Winstrol 2mg caps #30, give 1 cap daily.