Vanessa's Recheck at Tufts
Vanessa saw Dr. Carrera today, July 23, 2008, accompanied by myself and
Priscilla, for her FOUR week follow-up visit.
My Own Observations
Vanessa is walking without a sling. She continues to scrape her back nails
on the pavement, right worse than left. She walks best after a nap. She
becomes more uncoordinated in her rear as she tries to pick up speed, or
when she takes a sharp corner, but will catch herself and settle down in a
sit or a down. She has minimal ability to push off her rear legs to get into
a car. Stairs are going to be a challenge. She does better going UP the
stairs than going DOWN, and this is the place in the house where I am on
110% alert. Luckily, she listens well to me, is never too far from me, and I
have a gate at the top of the stairs and am well conditioned to keeping it
locked.
Our Conversation
Dr. Carrera said most of her cases, as a neurologist, have GRIM outcomes,
and some have GOOD outcomes, but a small majority, GREAT outcomes, and
Vanessa's one of them. She said Vanessa's situation is the type of case that
keeps her going. She felt she should continue to show improvement over the
next 1-2 months, and then we'll see her fullest potential. She spent some of
the visit loving up Vanessa, said they all loved her there postop, gave her
lots of belly rubs, said very sweet dog with great disposition, as we
already knew.
On a side note, we were talking about ticks, and she mentioned that she
(Tufts?) prefers Frontline over Advantix because she felt it kills the ticks
better.
She said she should be past the surgical pain, that any residual pain now is
probably inflammatory, and to take Rimadyl the same way we would take an
Aspirin or an Advil for joint pain, as prescribed.
She said that the big danger period is over in terms of a fall, but to
continue to be very careful around stairs and when picking up speed as we
increase her activity. She said we can use the harness just for safety now.
She said to use a harness with a handle and support toward her back end for
climbing stairs.
When I asked her about swimming at the beach or a pool, she said she not
only would allow it, she would encourage it, starting gradually.
Discharge Report today
"Vanessa had a recheck examination after having spinal surgery one month
ago. for a herniated disc. On exam today, Vanessa is bright and alert and no
cranial nerve deficits were noted. She is able to walk well on her own, but
is a bit uncoordinated and weak in the back legs, more so in the right than
the left leg. Her proprioception, or knowing where her feet are in space, is
still delayed in both back legs, right worse than left. The reflexes were
all normal. The cutaneous trunci, or skin twitch, is still abnormal on the
right side, but this is consistent with her previous problem. She does not
appear painful."
"At this time, Vanessa is much improved from when she was discharged from
the hospital! She is expected to improve gradually over the following
months. There is no way to know how much more she will improve, but it is
still early in the healing process of the spinal cord."
"At this time, Vanessa's activity can be gradually increased. Her walks can
become longer and she can begin to maneuver stairs. At first, a sling should
always be used to make sure that she does not fall and hurt herself. Also,
if you have access and Vanessa likes it, swimming is very good exercise and
should help recover muscle mass and strength in the back legs. You can try
this once and see how well she tolerates it and how long it takes her to
recover as it will be strenuous exercise."
"Vanessa is wonderful dog! Please do not hesitate to call or email me with
any questions."
Medication and treatments
*Rimadyl as needed for arthritis pain
*Heartgard continued
*Frontline continued
*She has now been weaned off her Prednisone, Pepcid, and Tramadol.
*Continue PT exercises
Follow Up Instructions
Vanessa does not have to be seen again so long as she is doing well.
**************************************************
"Oh, no, not THIS place again."
"Ewww. That dog over there don't look so good."
"Hi, Dr. Carrera, Nessa can't wait to show you how well she can walk."
"Yeah, hopefully THIS time I'll be sleeping in my own bed tonight."
"I hope you guys got better cookies since last time?"
"Hey, THAT tickles!"
"I'm a LOT more sensitive all over since you fixed me up, doc."
"A little bit to the left, please, you're doing good...WHEN can I come back
again?!"
New & Improved Vanessa
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