By: Revanche

Hemilaminectomy: A Doggle’s Tale

October 2, 2012

So the scar is pretty spectacular. I mean, the surgical site and incision is, anyway, it’s not a scar yet. But that’s starting at the end, or what is currently the “end” of a story that we’re still in the middle of. And I confess to being tempted to show you a photo but I have been accused of being gross for such things before.

Doggle seemed to be middling-fair end of the week but, to my eye, distinctly on the downhill trend, at a rate that I was most certainly not comfortable with.

You have to understand that his rate of decline was most important here because he was on more ameliorating medication than he’d been on during his first episode, significantly more, his baseline symptoms were far worse to begin with yet he was deteriorating more and more rapidly as time went on.

I’ve got some experience in this area. And I’ve got some old, long-time professional contacts in this area, too. So I emailed after the consult with a detailed description of the exam, then added my opinion afterward. That’s when I got the confirmation that my side-eyeing of the situation was indeed accurate.

Things literally got worse overnight. Sunday morning, Doggle had gone from a dog that could ambulate and push me around the night before to a dog that was struggling to stand on his own, struggling to walk more than six paces without his hind end falling and, struggling to keep his hind end from tipping over entirely one side or the other. A few times, he couldn’t and his entire body toppled over, and he was helpless to get back up.

That’s aside from the other obvious signs of neurological deficit, the dragging of the hind paws, the knuckling without correction, the awkward out-turning of one leg or the other as though it were a foreign object not truly attached to his body.

It was disturbing how he went from hours of trying to pace and fighting me to exhaustion Saturday night over being bed rested and crated to giving up from pain and discomfort.

And yet, it wasn’t easy to make the decision on Sunday to commit to surgery – it was a huge decision to put him under anesthesia again, to subject him to a major surgical procedure, to commit him to a serious multi-month recovery and rehabilitation effort.

The money was never an issue for me. I knew it wasn’t going to be debt so I was basically ready with cash in hand. We had already paid for the initial exam and associated costs: ~ $150.

Then the specialist exam and diagnostics (bloodwork, MRI): $2540

Quote: $4200-5000, or $4800-5600

It was a body blow to PiC, who has never dealt with major veterinary procedures and therefore their costs before. I had walked him through what I expected each line item to cost already but hearing it from the specialist, confirming I was right, was still a shock. It took all I had to keep my mouth shut and let him work through the equivalencies: “that’s one of X, that’s five of Z, that’s …”

In the end, that’s my dog and responsibility. That’s our dog. We’re not broke, in financial straits or in danger of being so, so there’s nothing more important to me than his life and health. That’s our dog’s spine and health and PiC would get there too. But he needed time that I didn’t need mainly because I already knew all of the health and the money stuff from my past life.

My difficulty was the pain he would go through and the reality of living with the decision. I’ve done various surgical procedures before with my other pets, though not to this magnitude and I know it doesn’t always go your way. Whether it’s the procedure itself or the recovery, things aren’t always routine no matter how “simple” it might be.  I’ve watched other people, many times, make the call and I know, it doesn’t always go your way. So I don’t care how “routine” the procedure is for any medical professional, I know that surgery is a risk.

We talked it through and ultimately, given his condition and the fact that he was still not responding to the medications and if he continued not to respond, we were going to be risking his chances to return to function. Backed by the expertise of a close friend, a veterinary professional with more than a decade of experience who worked with many decades of top flight surgical experience, we chose to operate.

We left a deposit for the low end of the quoted range of the procedure’s cost. That’s a bit more than I preferred to leave but that’s one way to take deposits, 50% of the quote is another standard deposit method.

One of the things that I didn’t like about this clinic was that I had to push them to give me an itemized quote – who gives me a ballpark range on a procedure and thinks that’s sufficient? I want to see an itemized list. The front office staff were remarkably shoddy in many respects, but I think the tech staff were generally good.

Another thing I didn’t like was that it called itself a specialty and 24-hour emergency hospital, but for surgeries that are normally scheduled during normal hours, they charged an emergency surcharge during the weekend.  Perhaps this is normal in the Bay Area but that’s certainly not my experience from Southern California.  You’re charged for the emergency consultation and then if you need the surgery, you pay for surgery and any related surgical costs, and that’s the end of that. You’re not charged another $600 for nursing staff to be called in because the hospital didn’t staff for emergency services when they claim they offer emergency services.

Perhaps they are minor things but they reflect on the clinic and make me wonder if they are indicative of the quality of care. But we were in a  bind and we were running out of time. I had to trust that, knowing in the past, we’d had horrible support staff with good vets before, that could very likely be the case here.

I was very nearly holding my breath the whole time. I most certainly wasn’t ready to deal with talking to people out loud – so I wasn’t taking phone calls from family or friends. Twitter was a lifesaver in that respect. Twitter, text and email.

Two hours later, we got the call and his procedure seemed to have gone well – and he was waking up fine.  Hurdles 1 and 2, surgery and anesthesia were passed.

Day 1 post-op: he was eating and able to get up, anxious and wanting to leave. Hurdles 2, 3, passed. But a new one presented: Anxiety level and our ability to keep him quiet. For three months.

We ended up paying just under $5000 for the whole surgical package and came home with a dog in a sling, medication,  small refund on the deposit and some hope for his back and legs.

He came home dazed, hurting, and scared.

Day 2 post-op: slept, drugged and dazed. We jumped up every hour or two to check on him when he lifted his head, or shifted a foot. We do not have this co-parenting, taking shifts thing sorted, or in any way down. We are zombies by morning. 5:40 am: I am oozing out of bed to try and give him medication. Forget jumping. Who has the energy for that?

The whole day was 98% keeping him calm and quiet, interspersed with learning how to get him up because he couldn’t figure out how to stand in less than ten minutes without hurting himself, walking in a sling holding up about 40% of his considerable bulk without unbalancing him or throwing out our backs or hurting ourselves, encouraging him to walk when he was too tired, scared or confused to.

He’s got no bladder control thanks to one medication he’ll be on for three more days so we have a ten foot radius of potty pads layered on top of each other, on top of towels on top of blankets.

I’m the medication unit so three times a day I’m making sure he gets dosed; unless he also needs a sedative when he gets so anxious and amped up for whatever reason and is in danger of harming himself.

This week is, as we were warned, going to be rough.  I expect that could probably be said about more than just this week, but we’ll see.

After this week, we’ll also need to see about a real rehab plan depending on how well he does.

The price we pay for a dog to have a little fun, hm? 🙂

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