Weeks 10 & 11 Spinal Walking

The last two weeks have not been very remarkable in any way.... just plodding on with our routines... 

We continue to have weekly acupuncture sessions, Dr. Neil Barnsley at the Animal Holistic Therapies was really pleased with Pennys progress last week.... I did not put her in the pram, but let her walk (stagger) in on her own two legs....  he even took a video of her walking.  He said when her legs get a bit stronger, he can start doing some treatments to help her bladder, which would be awesome.

I keep thinking her incontinence is coming to an end, because she is still trying to squat and sometimes a few drops come out, but I think it's just when her bladder is really full, she can not initiate a full stream on her own.  Expressing her bladder is easy, and if we do it 4 times a day, her bedding stays dry... otherwise when her bladder gets full it does leak out a little.... 

Poop, though is a different story... poop poop everywhere like a little trail of breadcumbs.... so now that she has a little more mobility, I have been letting her spend more time outside after expressing her, in hopes that she will poop outside, but it hardly ever seems to work... she always just goes on the floor when she comes in.  She also consistently poops when she barks.  So I thought, ok, maybe it's because I pick her up, and that makes her go.... so I started picking her up outside and walking her around, then put her back down on the grass..... nope, nothing.  As soon as I bring her in, yep, poop on the floor.  Thank goodness we have wood laminate floors  and her stools are firm.  (the downside is that the floors are slippery and she slides around on it.... still waiting for the booties I ordered to come in)  Anyway, there just not seem to be a way to predict when, or to help her to actually "go" outside..... One night, she did her usual, and I picked it up and cleaned the floor, but I still smelled dog poop... check our shoes, double check her bedding, check her feet and her bum... no  poop.... wheres the poop?  Put my hand in my hoodie pocket...yep... poop surprise!  Lovely.  

In week 11 we expanded her pen to a penthouse... 

Lady Penelopes new penthouse

We are hoping that the addition of the pee pad will encourage her to use it, should she feel the need.  

We were so encouraged Kane built ramps in and out of our doggy door, and out the back sliding door for Penny... she manages them in a noodly wobbly drunken stagger sort of way, and I don't feel confident leaving her unsupervised at the moment, but it is nice to see her able to make her own way when she wants.  

The hard news this week was from our physio... Pennys physio  said she was "spinal walking" (aka Spinal Locomotion) which I have learned means her back legs are automatically following her front legs in a sort of body memory way.... she still does not know where her feet are, and has adapted. Our physio thinks this *could* be the best Penny gets, as nearly 12 wks post op, most improvement is seen in the 1st 6-12 wks. Of course she did go onto say, she didn't want to be discouraging, but for us to be aware of the reality, and that Penny *may* get some more improvement over time, and no idea if her bladder/bowel control will come back at all....

We always knew Penny only had 50/50 chance of walking again, so we are not devastated or anything, just trying to get our heads around having a "special needs" pup... and worried about what the best next steps for us would be... there is some discussion here and on the IVDD support fb site as to whether or not we should get her wheels... I don't know if this will help or hinder her recovery... I have posted the question to the Dogerslist forum. 

.... We will continue with all the treatments- acupuncture, physio etc till we have exhausted all chance of further improvement of course... (even though it's costing us a bomb! LOL) 

Lifted from The Dodgerlist website:

"Animals have locomotor automatism, meaning that the basics of walking are hardwired into the spinal cord of domestic species. 
The brainstem adds the remaining ingredients for rudimentary, voluntary locomotor activity. The cerebellum adds smoothness while the cerebral cortex provides behavioral direction." The Neurologic Examination. R.M. Clemmons, DVM, PhDWhile a dog with severe spinal cord injury does not have deep pain sensation meaning their legs can no longer communicate with the brain, some figure out how to "walk" by using their rear limb reflexes. They learn to swing their legs into position underneath the body. The leg movements look jerky or motorized. The "walk" is in a straight line, as the brain is not involved to tell the legs to change direction to avoid falling."

Lifted from Handicapped pets.com blog:

"It is a spastic, motorized-looking movement of the back limbs of neurologically impaired dogs (and other animals) that propels them forward with an odd but effective gait. In crude layman's terms, the neurological signal bypasses the brain and it is a reflexive motion not dependent on the (damaged) neurological pathways to complete the process. From what I understand, this is an oversimplified explanation, but it conveys a rough idea of what occurs. ....(sic)  "

Also from The Dodgerlist website in the 'Ask section' Dr. Jared Galle, DVM Diplomate ACVIM (Neurology),:

"In my experience, dogs that do not regain deep pain perception (sensation) after 6 weeks rarely regain it.  Notice, I didn't say never!  These dogs often times will regain motor function and appear to "walk" once they get their legs under them.  When this occurs we call it SPINAL WALKING.  The "walking" is actually reflexes in the rear limbs being stimulated, which gives the appearance that the dog is walking.  These are involuntary movements and do not require the input from the brain to occur.  If you watch carefully, the front legs and back legs are not in sync with each other.  We do see paralyzed dachshunds that never regain deep pain perception but spinal walk several weeks or months after surgery.  These dogs live a great life!"

I was thinking that because I could see her actually "lifting" her back legs and stepping forward with them that she was recovering and that her nerves were "getting there"  Apparently I was wrong.  It does not mean that at all... 

She has adapted to her new normal...I think I may have had one day where I didn't actually cry.... I guess I'm adapting as well. 

 

Week 8 & 9

Finding the "New Normal"

The daily routine is really grinding us down, it is so much work, but it is obviously paying off!  Penny can now waddle along on noodly legs, and hold her weight pretty well, one side is stronger than the other, so she often lists to one side.  She will drag her legs behind her, then sort of lever up onto them, take a few steps.... actually lifting her feet and moving her leg forward from the hip for 2 or 3 steps, fall over and do it again... 

So the last two weeks have brought only minor changes, but they do add up! It's the little things, like she is licking her bum... ok, gross, but you know, a good sign that some feeling is coming back....Unfortunately, she is still incontinent.  I was hoping it would be starting to come under her control by now.....but it obviously is just going to take longer.  

We have had another 2 acupuncture sessions, and Dr. Neil says Penny is improving, and getting stronger every week.  Her treatments now include the needles being hooked up to an electrical device that sends electric pulses down the needles and across the spine.... she really does look like Frankensteins dog when she is all hooked up.  In the last treatment, for the 1st time, she didn't really like it, she kept turning around and trying to get them off, and shaking, trying to remove them.... usually she is kinda in a trance.  Dr.Neil says its a good sign....

We have had another physio session with Dr. Naomi, and some of Pennys exercises have changed, increasing in difficulty.  As Penny is now doing a lot of "hand-standing" the focus is on trying to engage the rear legs to bear more weight, so we have to put her front legs on a book and lift one front leg at a time so her weight moves into her rear legs and transfers from side to side.  Not as easy to do as you would think!  She still trys to hold all her weight up front, and then because one side is stronger than the other, on the weak side she ends up balancing on 2 legs.... so challenging to make her use both rear legs, its a fine balancing act of treat-coercion, co-ordination, firm handling and patience.  If we get it once or twice for 3 seconds we feel we have achievement!

Winter Magic came and went.... Lady Penelopes 1st Winter Magic absence ever.  We had to leave her at home but took little Gidget.... who took 2nd place in the Pet Parade!  Thanks to Leura Doggie Store and Katoomba Vet Clinic for hosting!  It was really fun.  Truffle the Magic Dragon came 1st, so we felt it was all in the family....

Then we had our final follow up appointment with the surgeon Dr. David Lidbetter.  
He examined her, and tested her strength and asked us a lot of question on what we had been doing, so we told him, physio 2 x a day, with weekly sessions with Dr. Naomi Boyd, , weekly acupuncture with Dr. Neil Barnsley, ester c, rose hip vital canine, walking in the bath 2 x a week.  Kane showed him a video of Penny walking.

He said she was doing much better than he expected.   *yeah* !

We talked then about the on-going expectations.  She still needs to be in her pen mainly 24/7, for another 4 weeks which makes it 13 weeks post op.  But that for her own safety, he would keep her in there while we are out, and at night, pretty much till she is fully ambulatory (so the flip side would be, if she is not fully walking she has to stay in her pen during un-supervised times) .  So she can be allowed out of the pen, with supervision, to scootch around, on grass or carpet as long as she does not hurt herself (stairs, falling off furniture  etc) or get raw spots on her skin.   I wanted clarity on this, because some comments on the IVDD fb site had led me to believe that scootching was bad, and that she could harm herself, ... but no, at this point post-op (9 weeks) , there was no harm in her scootching on flat ground, as long as she is motivated to *try* to get up, and in actual fact it was good to let her move around, to build up her strength.  

He said to keep up the physio, the more energy we put in, the more we will get out.... so thats good news that our efforts are actually effective!  He also said that the more she tries to walk, she is getting her own physio, so we will need to do less of the stand/sit type exercises.  

There was a long discussion about her bladder function- he wanted to know if urine just dribbled out all the time, or only at excitable moments, does she ever initiate or had a full stream on her own?  So I explained that we were expressing her bladder about 4-5 times a day, but when we came home, someones knocks on the door, or when you pick her up in the morning it would dribble out.....   He seemed to think this was good, and so he did not prescribe any medication for her.  He said it would be pretty unusual if as she gets more control of her legs if her bladder function did not come back, so just be patient.  I told him it wasn't the pee so much as the poop, and told him of her trying to squat, but still having *no clue* that she was going..... again, just be patient and be glad shes not a ridgeback...LOL. 

We also talked about the long-term do's and don'ts.... the list is unfortunately growing.... I wish we had known all this from the beginning... maybe I just didn't ask the right questions.  Anyway, heres the list:

• no jumping, 
• no stairs, 
• no playing ball, 
• no slippery surfaces, 
• no running at the beach on soft sand, 
• no playing with dogs larger that she is, 
• no wrestling, 
• no tug of war, 
• or running at high speeds 

Basically, any activity that causes jarring impact, or overt bending of her spine is off the table. For the rest of her life, we’ll need to try to keep her spine as ‘straight’ as possible, as often as possible.  

$65 for that follow up, and no need to see him again, unless her situation changes, and he wants us to email him an update in 6 weeks. Once again I was struck with how nice he is, and how patient he is with all our idiotic questions!  

In week 8 I had a lovely conversation with Chrissy from the Dachshund IVDD Australia support group, she is a really encouraging, supportive lady!  So much experience and so much love for our little 4 legged friends.  She offered Penny to be one of the Rose-Hip Vital canine recipients in a 6 month free sponsorship, but as we had already purchased some we declined, so someone else can take advantage of it who may need the financial support more than us ATM... she also suggested little non-slip booties for the house, and a back brace for Penny.  Both which I am looking into.  

I also read a fascinating blog written by a Canadian lady about her 2 french bulldogs and her experience with IVDD... her story is very similar to ours, except of course we have dachshunds.... (way more cute in my eyes.... ) it was nice to read a blog and hear her personal experiences with the highs/lows fully documented, and to see how she is faring 2 years on.... 

https://ouroslo.wordpress.com/about/

Week 7 Post op

I have now caught up the blog to real time, and I will continue to update Pennys progress weekly.  

For the 1st time in 7 weeks my heart is not so heavy, but I have to admit to still being quite depressed by all this.  I feel a variety of mixed emotions- 

Hope:  Penny will get better, and be able to walk and will be continent again... but I am filled with doubts,  and know she will never be the same again. 

Fear:  This could easily happen again, or it could happen to Gidget... how are we going to manage THAT, fark!

Guilt: 1st, The money, of course. So many other uses.  So many need it more than my dog.  All those poor stray dogs in India, children needing medical attention, etc, it seems selfish to me to have spent it on Penny when so many others could have benefited from it. The words of my family haunt me... would it have been better to put her down? 
2nd: If I looked after her better- not allowing her to jump, play with big dogs, chase her ball etc maybe this would not have happened.... it's my fault somehow....

Doubt: Have we done the right thing "by Penny"  were we being self-serving because we could not bear to live with out her?    Is she happy?  Are we doing everything we can to help her heal and get better?

Anger:  Why did this have to happen to us?  Why can't things just go back the way they were "before"

Resentment:  OMG all this time spent on Penny.... Penny this and Penny that.... wheres my time?  I feel guilty going out, or even having a shower.... I should be doing things for Penny.  

Pathetic:  Is pathetic an emotion?  Any way I feel pretty pathetic crying all the time and not just "getting on with it"  I mean compared to others our situation is just one tiny dog who can't walk.  Get over it.  

I'm sure all these feelings are quite normal, but geez it's a lot to bear, and not sure if I'm strong enough......

This week continues to see small improvements... Penny continues to try to walk, and is getting better every day.  We have had another acupuncture and another physiotherapy session.  She is still in her pen 23/7, as she is still incontinent and we have not had clearance to let her out from the surgeon yet.  That appointment is still 2 weeks off.  

We filled the bath tub and marched her up and down, Kane had to put non-slip adhesive down for her, as it was way to slippery the 1st time.  I'm not sure how effective it is, but we are trying to  following the instructions on:

www.k9physio.com/wp-content/uploads/2013/06/Hydro-at-Animal-Physio-Services-2013.

And we have been pretty religious in doing her physio exercises 2ce a day.  Some of the exercises are harder than others, and she is learning how to cheat by "hand-standing" so I will ask at our next appointment how to encourage more weight onto the back legs.  Here is a list of exercises we are doing: 

• An electric toothbrush to each toe pad 5 x.  
• Then toothbrush from toe to outside ankle to knee 5x . 
• Then toothbrush for 2 mins around the vulva, and the sides of the tail... (this always makes her pee, so we do it outside)  
• Then from sit to stand 5 x , and she has to sit correctly with her legs under her, not out in front like a kangaroo. (we usually do more than 5 x) If she does not sit correctly, we just have to try again, often her back legs "lock up".
• Then puppy pilates- front legs on a 1/2 filled hot water bottle, back legs on the table and shift weight from side to side 5x
• Then marching in place- pinch her toe till she lifts her foot- direct her foot back down, and do the other leg. She is still having a lot of trouble placing her foot back down and shifting her weight to the other side, but the fact that she can now stand the whole time we are doing this is a great improvement. 

Following some advise from the Dachshund IVDD support group, we now put little Gidget up on the table so she can see what we are doing and join in.  When Gidget sits, she gets a treat too.... this has helped with the frustration aspect of having Gidget whining and jumping up to see what we are doing with Penny.   It's still challenging to wrangle two dogs on the table, but it's easier than dealing with an unhappy jealous Gidget LOL. 

Little things are starting to happen... She is trying to squat when I express her bladder and I can see her trying to squat at other times and if I notice I take her out.... poop!  So I do think in the next couple of weeks she will get control of her bowels- it's looking very promising!  She is doing more "doggie" things, like she now rolls over so you can pet her belly (completely voluntarily), she's sleeping curled up, she's licking me- and everything really.  She tries to stand when eating, she lists to one side and then eventually falls over, but she's trying to stand, and the length she can support her self is getting longer, of course she is using a lot of front-end strength "hand-standing" but still, she is getting herself up onto her back legs more....

Next week: Finding the "new normal".....

Week 6- Acupuncture & some Action!

Let me tell you about our Holistic Vet experience.  

The practice is in Greendale, a part of Western Sydney I had never heard of till now... it's near Wallacia.  It took us 1hour and 15 mins to get there, so a bit closer to us than the physio in Homebush.  

It's in a low key house, with a concrete parking area.  As you get out of the car, you are in a completely rural setting.  Cows in the paddock across the road.  You can tell it is an unusual place because of the horse hitches off to one side. 

We wait a bit while Dr. Neil finishes treatment on a greyhound and we go in with Penny.  Dr. Neil is a young, tall dark haired gentleman with a soft spoken manner.  He gives Penny a once over, feeling her spine, neck and legs, and testing her for a Deep Pain Response with a tiny needle between her toe pads (we were gratified to see a jerk! )  and asks us lots of questions about the surgery, and says he will give Dr. David Lidbetter a call (turns out, they know each other).  

We have a chat about the injury, how it happened, when we noticed her going down, the timeline etc.  Dr. Neil said that he prefers to have paralysed dogs who have NOT had surgery, he said he feels he can get them back on their feet quicker and better than ones who have had surgery.  Not 100% sure why, but I think it has something to do with scar tissue and keeping the discs intact.  He goes onto say that Pennys results will be individual, there is no predicting an out come as to whether or not she will walk again or regain continence.  The good thing is that she is only just 6 weeks post op, that we did not wait to bring her in, we have started early.  

So we begin treatment.  He starts by giving her acupuncture- tiny needles on both sides of her spine from her hips up to her shoulders... maybe 8 in all... Penny was so calm and still.  After the needles were in, he used a directed infra red laser light gun to target the inflammation, and stimulate nerves around the scar tissue.  He goes slowly up and down the spine.  Penny is now nearly asleep, if she was a cat she would be purring.... so relaxed, her eyes closing over and her head leaning on my hand... it was weird!  Then he takes out the needles and uses a chiropractic activator down the bony protrusions of her spine- this to increase blood flow to the area (I think).   All done.  

I ask him about supplements, and tell him Penny is on 1000mg of Ester-C per day, and did he recommend anything else for her? He gave us a bottle of something called Hernidisc which is formulated for humans post ruptured disc surgery and he tells us to give Penny 1/2 a table per day with food, he said it has worked well in animals and to try it.

The cost for all this? $75, including the supplements!  So very affordable, we couldn't believe our luck!

We kept Penny calm that night and the next day just did her light physio exercises as usual, but the day after that, we saw some remarkable improvements in her.  She was able to stand on her back legs for longer, from about 10 seconds to nearly 30 seconds before she goes off balance, she pulls herself up onto her back legs and trys to WALK... we can see her hips actually making front/back motions, and although most of her weight is on her front paws (hand-standing) she is actually taking about 1 step in 3 or 4.  She drags her back legs, but she is up on her knees, then gets her legs under her, and takes a step or two, wobbles and falls over and tries again.  She is still knucking her toes under, but her toes will be the last things to come back.  

She has also started to squat when I am expressing her bladder now, which can only be a good sign!  

Week 5....

Week 5.... more of the same... 

Penny had her second physio appointment, and Dr. Naomi put her on the full body vibrator.  So the dog stands with front paws on a low book, and rear paws on the vibrating plate.... I think the idea is to stimulate all the nerves in the rear..... Penny had to sit/stand/march while the plate was vibrating.  When I say march, you know... not real marching... 'cause Penny can't lift her rear legs up, but you pinch her toes till she jerks up her foot and then you put it down for her.  Her reflexes are good but no "proprioception" (means she has no clue as to what her feet are doing... no self awareness) All we can do is keep at it. Naomi suggests we video her, as working with her day to day, it's hard to see any improvements.... a good suggestion.


A recommendation was made to look at Holistic Vet, and I do some research on it, and remember Dr. David Lidbetters advise to find a good one with experience.  

Dr.  Neil Barnsley at http://animalholistictherapies.webs.com/

name comes up, on the fb page and from a friend who is a vet-nurse, so I make an appointment for next week.

I try to take Penny to work with me at least one day a week, but I am very cognisant of the fact that her incontinence can really stink up the office, so she has to wear a nappy and I have to clean her up immediately. It's a pretty big ask for the ladies in my office to put up with.... I am so lucky everyone loves Penny!  

Fortunately, by now, I can sort of badly predict when Penny needs to poop so I can take her outside in time- if she gets excited and barks she poops. And she does tend to poo if you pick her up, so theres that. It's really nice when you pick her up and she drops one on the floor, and you don't notice it, and then you step in it.... But most of the time, it is becoming more manageable, morning noon and night. The pee is not so bad, as she usually just goes when we pick her up and when I express her bladder which I do 4 times a day now.  

The Ester-C seems to make her more thirsty, and when she is in her pram, I have to remember to offer her water every hour or so.

The depression is so heavy.... I continue to cry for no reason, and try to gain strength from all the recovery stories.... 

Week 4

I think this week is where the depression really set in.  

It was more than just the added stress of looking after our little doggy.  It was more than the sleepless nights and worry about money.  It was more than on-going anxiety about repeat injures.  More than how long was it going to take and how long would we hold out, as if there was an option!  It was more than all those things, I think I finally came to see it was that I was missing my friend.  My shadow.  I was missing all the doggie things- the walks on Sunday up to the lake, ball throwing and her happy face, wriggly butt dance when I came home, even the  little things like scratching herself, licking, and sleeping with her nose tucked under her paw.  I miss her, and even though she  is still with us, nothing will ever be the same again.  

Some things people say re-play in my mind like a broken record.... from family members:  

"Theres a cure you know, it's called a lethal injection"

"How long are you going to do this, whats your deadline"

"Penny sure is lucky, I wouldn't be driving my dog all that way for acupuncture, he'd be getting a different type of needle" 

I never know how to respond to these comments... I think they are said in jest, but with an underlaying seriousness....  so hurtful. 

This week did see some tiny slight improvement ... Kane swears she wagged her tail, and she did pull herself up onto her hind legs to get a drink.  Week 4 is the all clear to start some hydro-therapy, so "J" lent us a clam shell pool, which we filled with a hose out the window with  warm water.  We put her in and walked her around and around.  It really was just not *quite* deep enough, although she did get some buoyancy in her rear.  We will have to try it in the bath tub next and see if a higher water level does anything.  At least it was something new! 

We started her on 1000mg of Ester-C this week, as recommended by the amazing ladies on the Dachshund IVDD Support fb page, and we are giving Gidget 250mg a day as a preventative.  

But overall, not much happening.  I think her boredom is setting in, like my depression is setting in.  

Week 3 post op

Week 3:  
I spent a lot of time last week on various dachshund facebook sites including this one: 

www.facebook.com/groups/dachshundivddsupportaustralia

and I must have read every word by now on the Dodgers List web-site.  I posted questions on the fb page about physio therapy, and asked if anyone had any recommendations in western Sydney area, and how good were they, and if they felt it was worth it on their dogs.  I had several recommendations, none near us, of course, but the consensus seems to be to start physio as soon as you can, and it does really help!  The amazing stories out there about dogs paralysed for 8 months, 12 months, 21 months and learning to walk again are inspiring.   they all make me cry of course.  One particularly touched me, the story of "Frankie" who was in a wheel chair for 4 months, then put up for adoption and his new owners did physio with him for a year, and he is walking again!  How do the people do it?  I'm 3 weeks in, and no better emotionally than when Penny went down.  

Anyway after a few recommendations and web-site searches, I made an appointment with Animal Physiotherapy Services in Homebush.  I have to say communication with them is not so good via email.    Due to poor communication, the physiotherapist did not expect to see Penny had spinal surgery- even though I had been very explicit in my email as to date, surgeons name and follow up letter from my local vet, all as requested.  However  Dr. Naomi Boyd was really good, even when put on the spot.  I went down with my BFF "J" as Kane was working-  and Naomi talked us through the recovery process.  Basically, nerves grow from the back down, so starting at the injury point and working their way down the back, hips, knees ankles and feet, so you start to see improvement 1st at the hips, tail wagging etc.  The nerves need to find a new "highway" so send signals from the brain to the legs.  Then the brain needs to re-learn how to use these new pathways and so the physiotherapy is focussed around stimulating nerves, supporting and stabilising the front end, and encouraging movement in the rear limbs.  

Naomi then showed us how to do the exercises with Penny, how to support her, and use treats to positively re-inforce movement.  We came away with various exercises for encouraging standing, balance, and leg movement in varying degrees of difficulty, including massage and some light vibrator action.....with an electric toothbrush.  We need to do these 3 to 4 times per day, but we do not need to do the passive resistance exercises any more.  This was going to be hard to do on my own.... time to get a roster for hubby and I!

A small lump developed on Pennys back this week, it felt like fluid, just over her scar.  

so off we went to the local vet, and she was not too concerned about it, but still we took a picture of it, and sent it off to the surgeon, Dr. David Lidbetter.  'Aint technology grand?  David wanted us to ice it several times a day, which we did, and it went away in a couple days.  

This week we also went to the RSPCS's Million Paws Walk.  Penny barked and barked... pretty sure she wanted to sniff butts and lick people, so she was not very happy in her pram.   however she did win "bravest dog" ( I thought "longest scar" was better..... ) and came home with a stuffed toy that didn't last long.  Gidget had a great time...

This week Kane came down with the flu, so being self employed, the financial situation was not improving.... I had really planned on using all the money we got from donations $1450 all up, only on Pennys on-going treatment and emergency pet fund.  I did put $400 in a savings account, not at our usual bank, and in an account with no ATM card to make it really hard to withdraw.  I bought a special booster car seat for her, some extra meters of fleece, Ester C vitamin supplement (not cheap that stuff), puppy pee pads, dog food, special chicken treats and a few other odds and ends for her.  Then I did pay for her 1st and 2nd physio appointments, and 2 extra vet visits,  which was great... then unfortunately with Kane being out of work, we did have to use the rest to pay bills.  I really wish we had been able to just use it on Penny, I feel guilty having spent "her" money on our bills.  The rest of her treatments will have to come out of our household budget for as long as we can manage them.