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Post by Beth & Pebbles on Sept 23, 2014 18:50:41 GMT -7
This is my first time posting. I have a 4 year old female long haired miniature dachshund named Pebbles. Pebbles had IVDD and had surgery back in May of this year which I thought was successful and she had returned to normal until Sunday night when I noticed she was experiencing the same warning signs again (I have another doxie who had the same problem and surgery last year as well so I have become familiar with the signs). She was holding her head up higher than normal while not wanting to use her back legs. She still was able to walk normally and wag her tail but did not want to walk. I crated her immediately and took her to the Guelph Ontario Veterinary College Hospital (Canada) where both my dachshunds had their surgeries. They suspected the same thing as me, IVDD. She stayed overnight so she could have hydromorphone and I picked her up Monday at noon with instructions for crate rest for 6 weeks and metacam, tramadol, and gabapentin (spelling may be incorrect). Since then she has deteriorated significantly. She is still eating and drinking, last went pee about 6 hours ago when I took her outside to use the bathroom and pooped recently in her crate. She is pretty much dragging her legs now (I only took her out to use the bathroom and this is when I observed this). She still has some tail movement. My concern is that she is getting worse and I am unable to do another surgery for her. Is is normal with crate rest for the dog to get worse before they get better? How will I know if I have to express her bladder if she ends up paralyzed? I would do anything to keep her alive that I can as long as she has a good quality of life and can be happy. I am open to a wheelchair although it seems early to look into that. Is it possible for her to still get better with crate rest if she ends up losing all mobility in her back legs? Any help or advice would be greatly appreciated. -Beth
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,570
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Post by PaulaM on Sept 23, 2014 19:16:04 GMT -7
Beth welcome to Dodgerslist. When there are symptoms more than just pain moving to loss of neuro functions most vets will want to move to the most powerful of the anti-inflammatories. The steroid class. Metacam is in the non-steroid class of anti-inflammatory drugs thus the lessor. There is serious consideration to switch classes without a 4-7 day washout. When there is an emergency deemed then TWO GI tract protectors will be on board. I see no GI tract protector is on board with the metacam... should be. The usual is Pepcid AC www.petplace.com/drug-library/famotidine-pepcid/page1.aspxDo you have an ER you can get to or first thing in am your vet. Hours count with nerve loss. Can she still wag her tail specifically if you do some happy talk to her? How is the pain, fully in control? Let us know about bladder control. Urine leaks in bedding or when lifted signal bladder control loss. Sniffing an old pee spot and then choosing to release urine there is proove of still having bladder control. Bone up on expressing before the vet lesson here if you determine it has been lost: www.dodgerslist.com/literature/Expressing.htmWhen you can give us a list of meds with mgs dose and how often you give each You will want to read this page even if not doing surgery so you know the neuro signs to be monitoring: www.dodgerslist.com/literature/healingsurgery.htmThis page will give you a good understanding of the anti-inflammatory drugs and how they work to decrease swelling so you and your vet can have a conversation as to which path to follow: steroids or continue with NSAID metacam. Nerves don't like swelling, when pressured they die and we see that as loss of function. Nerves can grow back if not fully damaged with time. www.dodgerslist.com/literature/healingsweling.htmNever give up, stay focused, stay postitive and stay strong! |
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Post by Beth & Pebbles on Sept 28, 2014 13:32:48 GMT -7
On Wednesday I called the small animal clinic at the university where both my dogs had their ivdd surgery and asked about getting pebbles on steroids but they said it wouldn't help her. Instead they upped her dose of
▲gabapentin from 0.6 mL every 8 hrs to 1.2 mL every 8 hours. Her other doses are
tramadol 10mg capsules, 2 capsules every 8 hours and
meloxicam 1.5mg/mL dosage done by 5kg weight mark on syringe.
As far a pain is concerned she seems okay most of the time. When she goes from the sitting position to a lying position she struggles a bit and kind of trembles. Occasionally she is whining a bit, usually just before we next dose of meds. She was also foaming at the mouth when I have her the tramadol but when I called the vet they said it was from the bad taste of the medication. She hasn't had any other symptoms related to the foaming (no seizures etc).
Her bladder control isn't good. When I lift her she does sometimes pee on me so from the article it sounds like she may have lost control of [bladder] it. She last pooped on Friday, I'm not sure if that is a problem yet or if it could be caused by meds. She is still eating and drinking. Yesterday I washed her paws and fur (she is a long haired) because it smelled of urine and I didn't want it to irritate her. I just put her in the tub with. Few inches of water and tried not to move her around much. Is this okay to continue doing?
I did some searching and found a vet in Toronto who has experience with ivdd dachshunds and steroids and we have an appointment with him tomorrow afternoon.
After her bath I had her up on my bed sitting on a towel petting her and talking to her and she was licking me but she does seem a bit depressed. If we can rehabilitate her or at least get her back to having control of her bowels I would be fine to get her a wheelchair but I'm not sure we would be able to provide enough care to her if she is incontinent. I'm on maternity leave right now so thankfully I'm home but I have a 2 year old and a 4 week old baby and I need to be realistic about what I can take on at this point. When I go back to work my husband and I will both be gone during the day. Is there still any hope of getting her back to having bladder control? Also, any suggestions on what I should talk to the vet about? I don't want to put my sweet girl down but I also don't want her to be sad or in pain.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,570
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Post by PaulaM on Sept 28, 2014 16:29:23 GMT -7
Beth, it sounds very much like Pebbles IS in pain by your reporting after moving to sit up she trembles and vocalizes nearing next dose of the pain med. Hope with the addition of increased Gabapentin, you will report back that the pain is now in control. Exactly how much does Pebbles weigh.... 5kg or about 11 lbs? If that is close, the the vet does have even more room to move up in dose on the Tramadol so that pain is better controlled. Methocarbamol is typically also used for the different type of pain... that stemming from muscle spasm. So if you are seeing pain, there is no reason for it because meds can be adjusted. You really do need to get a hands on top of your hands type of lesson to express the bladder if you are being leaked on AND if you see she no longer can sniff an old pee spot and then choose to release urine there. Voiding the bladder is how urinary tract infection (UTI) is kept away. So that appt with a new vet is very timely. Better to snip away some fur than to do any baths. Any time out of the recovery suite is dangerous. Baths are risky...wet dogs are slippery and they do that wet dog shake...bad for keeping movement of the spine limited. Use unscented baby wipes for quick clean up on your doxie. Marjorie's tip: boil and cool green tea. Dampen a washcloth, neutralizes urine on skin and fur to avoid rashes from urine scald + clean fragrance. White vinegar in a spray bottle to disinfect and remove the urine ammonia smell from floors, etc. Two spray bottles, one filled with plain white vinegar the other filled with peroxide . A spritz of each on urine and poop disinfects and removes the odor... good on linens, floors and other hard surface. Pre test for color fastness on important fabrics. articles.mercola.com/sites/articles/archive/2001/07/21/vinegar.aspxThe hard part of disc disease is we humans want so to get ahead and project things and we don't have a lot of patience. IVDD is a disease of patience. When a family member is sick we do what is necessary and not give up on them. Disc disease is a disease we can live with. So take one day at a time, give Pebbles the time she needs to heal... 8 weeks to heal the disc. Nerve healing may or may not come in that period of time. Now if the new vet deems it an emergency to switch between the two classes of anti-inflammatory drugs (NsAID such as Meloxicam to the steroid class) the stomach must be double protected. Her stomach is not even being protected now!! Due to potential serious side effects of NSAIDs, there should be blood work first to assess liver and kidneys health. The drugs may prolong bleeding times and interfere with clotting, and have the potential to cause life-threatening liver and kidney problems with or without warning. The FDA and manufacturer pkg insert also warns about gastrointestinal problems as the natural defenses of the stomach to shield against stomach acid is hindered when taking NSAIDs. Phrase the question to your vet this particular way:" Is there a medical/health reason for my dog not to take Pepcid?" If there is no reason, we follow vets who are proactive in stomach protection by giving doxies 5mg Pepcid (famotidine) 30 minutes before the NSAID. Good idea to not only read up on Pepcid AC but also sucralfate if there is intention to switch to a steroid with the new vet: www.marvistavet.com/html/pharmacy_center.htm |
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Post by Beth & Pebbles on Sept 28, 2014 17:09:35 GMT -7
I will make sure to ask the new vet about the Pepcid tomorrow as well as adjusting her meds for better pain control. They did do blood work when she stayed overnight last Sunday and I was told it came back fine. I'm sure the new vet will want to do his own testing as well. Thanks so much for all of the helpful information!
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Post by Beth & Pebbles on Oct 6, 2014 17:53:40 GMT -7
I just wanted to post an update about Pebbles. We took pebbles to the vet in Toronto and saw Dr. Mitelman who was amazing! He gave us new hope about pebbles and showed that she still had deep pain sensation and even got her to move her tail. Her new medication is as follows which started on September 30th:
Prednisone 5mg tablets - 1 pill twice a day for 10 days, then 1 pull every other day for 10 pills
Losec [omeprazole] 10mg tablets - 1 half tablet once a day
Sulcrate 1g tablets - 1 half tablet twice daily (1 hour before or 2 hours after a meal)
Methocarbanol 750 mg - 1/4 pill twice a day
Gabapentin and tramadol as needed (she gets tramadol 10mg at least twice a day)
Dasquin glucosamine chewable tablets - 1 per day
They also did X-rays which showed pebbles has a lot of solid material between her vertibrae that they said should have been removed during her surgery this past may. Her current problem is in the same spot where she had the surgery before which is upsetting as from the way the vet phrased things politely it could be that the surgery was not done properly the first time.
Pebbles is about the same now, a week later. She still has tail movement but no leg movement. What would I look for to tell if she is getting anything back in her legs? I know it's a very slow process but I want to know what to pay attention to.
Giving the medication has been the most difficult part. She really hates it and fights us. My husband has started wearing a glove as he holds her jaw open to force the medication in by syringe. We have tried hiding it in wet food, peanut butter, cheese etc and forcing pills down her throat but she always gets them back up. Any suggestions?
Also her bladder situation doesn't seem to be going to well. Before the steroids we seemed to be able to express her well and it was working out but now (I'm hoping from her being extra thirsty from the steroids) she seems to always be wet in her crate. I have been trying to take her out more frequently but often I only express a few drops and then an hour later she wets herself. As she is a long haired I worry more so about the urine scald. I tried putting the green tea in a spray bottle as I felt the damp cloth wasn't getting to her skin.
If anyone in ontario is looking for help with ivdd I recommend dr mitelman (www.vetstoronto.com)
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,570
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Post by PaulaM on Oct 7, 2014 8:48:32 GMT -7
Beth, can you tell us how much Pebbles weighs? What is the dose in ml or mg for the Gabapentin and how often do you actually give it 3x/day?? How often are you actually giving 10 mgs of Tramadol per day? It is quite possible that after the surgery disc material further escaped from the inside of the disc into the spinal cord canal. So the surgeon well may have removed all the escaped disc material he saw at the time of surgery. There are also situations where even the best of the best surgeons may have unknowingly missed a piece of disc material. Can you tell us if the movement of the tail was specifically due to some happy talk or seeing a treat? Both Gabapentin and Tramadol are very bitter meds. Once a dog gets a taste they will be forever suspicious of the pill. Make sure your fingers are clean of the dust after splitting pills. The pill needs to be place far enough back of the tongue. This video will help you with that idea. Also try the three treats method. Prepare three treats, one will have the pill inside. Give the first plain treat with #2 pill treat in view. The idea is a greedy gulp to get the next. With #2 in the mouth have #3 plain treat in view. Most dogs like sweet banana. The pill will stick inside a little ball. If need be wrap with a thin piece of deli meat to make even more yummy. The small size marshmallows also make a good pill pocket as the stickiness keeps the pill from falling out. When you express are you able to feel the shape of the bladder? The last stage to verify the bladder is empty is your ability to almost feel the fingers of your other hand as you press on the bladder because it has become rather flat, empty. Nerve healing is one of the 4 phases of healing and it is indeed helpful to know what to monitor for. Check out the orange button "Nerve Regeneration" for the order in which nerves self repair: www.dodgerslist.com/literature/healingnerves.htmIf you continue to find Dr. Mitelman to be an IVDD knowledgeable vet, please enter him in our Vet Recommendation directory: dodgerslist.boards.net/board/10/guidelines-posting vet recommendations: Name of Vet Name of Clinic Street Address City: State or country: Type of vet (general/board certified surgeon, acupuncture, etc.) Comments: |
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