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Post by Victoria and Allison on Dec 14, 2014 21:13:28 GMT -7
Hi, my 12 year old dog Charlie needs help! I'm not sure we are at the right place because he is a Boxer-Staff Terrier mix and weighs 85 lbs.
Yesterday his rear feet started knuckling under, his rear legs started crossing and he had a hard time standing and walking but could do it. I took him to an ER clinic and they took blood test/urine and x-rays of hips and back. His blood/urine tests looked good, hips are great but there is 'severe boney proliferation' at his lower back and sacrum. They gave me tramadol (150 mg 2x's a day).
I know he needs a work up. The cause hasn't been exactly determined. I told them Charlie hasn't wanted to get up at all last night or today except twice total to go outside and pee/poop (normal). The vet said to take him off tramadol to see if he gets up. He will eat but not as much. He just lays there. I was shocked that on day one of Charlie's symptoms the vet said, "well we may have to consider quality of life issues, you've done all you can, more than most...." yata yata like time to put him down?? Wow isn't there any hope for my Charlie?
If I read your site correctly, you would have me keep him on tramadol and keep him immobile for weeks to see if he comes out of this? And get him diagnosed, right?
Based on what I read tonight and because I am not ready to write off Charlie, I did give him his evening tramadol. He is not moving so he is complying with the 'rest' instructions.
Please if you can offer any help and suggestions, even if Charlie is big and not a dachshund. Thanks so much for ANY suggestions!!
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Post by Pauliana on Dec 14, 2014 21:45:15 GMT -7
Welcome to Dodgerslist. First thing to know is that it IS in the cards for Charlie to get back to enjoying life whether immediately walking or waiting on more nerve repair - IVDD is not a death sentence. Find out why that is true: www.dodgerslist.com/index/SDUNCANquality.htm Normally a dog with IVDD would be put on a Steroid or NSAID (Never both) to get the swelling down in the spinal cord.. Pain medications are a must.. such as Tramadol, a general pain reliever and or Gabapentin for nerve pain, as well as Methocarbamol if the dog is having muscle spasm pain. In order to help you more, could you please answer these questions? ☐ What is your name? Let us know how you found us: your vet, search engine, friend, etc. ☐ Did you specifically get a diagnosis of IVDD, aka: a disc problem, a disc herniation, a bulging disc, slipped disc? Not sure if the severe boney proliferation is IVDD. Yes, I would get a second opinion on what Charlie is dealing with. We have had some larger dogs with IVDD.. It's happening with many different breeds it seems. Larger dogs have different diseases that seem similar to IVDD such as Wobblers. If he has Wobblers the treatment is different. Dodgers focus and what we know a lot about is IVDD, a disease of the discs. Wobblers is a disease of the vertebrae so the treatment is different. vet.osu.edu/wobbler-syndromehandicappedpet.net/helppets may also give you ideas on caring for the larger dog. If he does have IVDD we are happy to advise and help.. Healing prayers for Charlie! |
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Post by Victoria and Allison on Dec 14, 2014 22:39:09 GMT -7
thanks for such a quick response and the encouragement. I'm not sure this is Wobblers as Charlie's issue is believed to be at the sacrum and I think Wobblers is related to the cervical area. I don't think Charlie has a Wobbler's gait. But more tests will be necessary. In the meantime I think following a IVVD or DM protocol might help Charlie and it sure is better than giving up as the vet started to suggest.
Poor Charlie is panting and I'm sure he's frustrated that he can't get up, maybe pain, maybe inability or maybe afraid.
Oh, and I'm Victoria Lynn and heard about this site for years.
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Marjorie
Moderator~ 
Member since 2011. Surgery & Conservative
Posts: 5,724 
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Post by Marjorie on Dec 15, 2014 6:19:44 GMT -7
Welcome, Victoria. Yes, until you know whether this is IVDD or not, you should follow an IVDD protocol, which would include 100% 24/7 strict crate rest for a full 8 weeks. STRICT means No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No PT, no baths, no chiro (aka VOM). Movement is what disrupts the scar tissue trying to form. If the disc tears then very likely neuro funtions will worsen as the disc pressures the spinal cord. So your focus during the 8 weeks of restricted movement is to do everything possible to limit movement of the back to avoid loss of leg and bladder function, to avoid a surgery. No walks, only a very, very few footsteps to get the job done. You have more of a challenge than we do with our little dogs we can carry to see best how you can limit his footsteps The restricted area should be only enough to stand up, turn around and when lying down fully stretch out the legs. If he'll go on a pee pad inside, that might be helpful as you could just place the pee pad right outside of the crate door. Do what it takes to limit the footsteps to potty. Keep the recovery suite by the exit door. Make a ramp over steps. If you think Charlie has pain, be sure to let the vet know ASAP so his meds can be adjusted. Tramadol works best when given every 8 hours (3x/day). Gabapentin works well along with Tramadol and also Methocarbamol can be added to the mix. Have no patience with pain. Pain is usually shown by shivering, trembling, yelping when picked up or moved, reluctant/slow to move head or body, nose held to the ground, head held up high, tight hard tummy. I would definitely speak to the vet, too, as Pauliana recommended, about adding an anti-inflammatory to resolve any swelling that may be pressing on the nerves of the spine. That's what causes the pain and causes the nerves to die, resulting in nerve damage. Knuckling and crossing of hind legs are signs of nerve damage. When the anti-inflammatory is started, be sure to have your vet add Pepcid AC 30 mins before the anti-inflammatory and every 12 hours thereafter to protect Charlie's GI tract from the side effects of the anti-inflammatory. You'll need to ask your vet if there are any health reasons why Charlie shouldn't take Pepcid AC and if not, what the dosage should be. Board-certified neuros (ACVIM) and ortho (ACVS) surgical specialists can be found at University vet teaching hospitals. You can locate others in your area here: www.acvim.org [neuros] online.acvs.org/acvsssa/rflssareferral.query_page?P_VENDOR_TY=VETS [orthos] Dodgerlist Members' vet recommendations - dodgerslist.boards.net/board/10/guidelines-postingPlease keep us updated after more testing has occurred or if you have any more questions in the meantime. Healing prayers for Charlie. |
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Post by Victoria and Allison on Dec 15, 2014 22:11:41 GMT -7
Thanks a million times. I have appt with board certified ortho who also deals with neuro issues at a specialty hospital on 12/22 and will see if cancellations permit sooner.
THE PEE PROBLEM
Charlie is not getting up on his own, at all. My biggest problem is that I have some serious physical limitations including I can't lift anything heavy and he's 88 lbs. I have help everyday from early morning to about 1pm and after that none. I just pray he won't try at night and then fall in it and I will have a hard time helping if that happens. I do watch him all night.
ANTI-INFLAMMATORY MEDS
This is Charlie's first serious back incident. He is pretty much down and not getting up on his own.
But this morning he did get up to go outside and pee and could walk, albeit with some knuckling and leg crossing. I do think anti-inflammatories are warranted. He had shown stage 2 kidney disease last year but yesterday's blood and urine tests showed absolutely no sign whatsoever! I think putting him on renal food early and his heavy water drinking helped him.
I will call my regular vet and the specialist and see if I can get the nsaids or steroids started. Do you have a preference? Do you suggest start on nsaids then move to steroids if necessary or??
PAIN MEDS
I don't see Charlie exhibiting pain except he pants a little which may be the known side effect
of tramadol. His not moving may be an indication of pain. Do you think that is enough to ask for a combo adding metrocarb and/or gabapentin? The vet said to start with tramadol 2x's a day but allows 3. Do you think I SHOULD do 3x's? I can do that immediately.
I am so grateful to your FANTASTIC group! To give hope that there is a chance to help all our precious guys.
I just posted Charlie's photo: Charlie the Gentle Giant (in happier times). THANKS AGAIN!!
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 16, 2014 5:47:52 GMT -7
Yes, please do speak to the vet or specialist about starting an anti-inflammatory ASAP. The sooner that swelling resolves, the less risk of more nerve damage occurring so it's vitally important. Whatever anti-inflammatory is started is the one that you want to stay with. To switch from a NSAID to a steroid requires a 4-7 day wash-out period where Charlie would be without an anti-inflammatory. A steroid is a stronger anti-inflammatory than a NSAID, although some vets are hesitant about prescribing an anti-inflammatory level of a steroid, which tends to be on the higher end, and may want to prescribe a NSAID. I would request that a steroid be prescribed.
Please do restrict Charlie's walking. You said that he walked outside to do his pee. Do you have the crate near the door? Please don't allow him to walk up or down any steps. If he's in a wire crate, castor wheels can be purchased so you can wheel the crate outside, down a ramp over steps. Do everything you can to restrict his walking so the disc can heal and to prevent further nerve damage.
Tramadol does work best when given 3 times a day as it has a short half life. Do let the vet/specialist know about the panting. Panting can be a side effect of the meds. A fan near but not pointed at the crate will help. Also a rice sock from the refrigerator can help them cool by laying their tummy along side of it. Fill a sock with 1-2 cups of rice and tie the end of the sock closed. Try a frozen broth ice cube to lick on. Or it can be from anxiety. Or it can be a sign of pain. If a fan helps, then it is most likely a side effect of the meds. Keep an eye out for other signs of pain.
When you go to the vet/specialist, you shouldn't give the Tramadol that morning so there can be a valid examination made by the vet as he'll want to examine for pain.
And be sure to speak to the vet/specialist about adding Pepcid AC 2x/day once the anti-inflammatory is started. And give the anti-inflammatory with food.
Please let us know what the vet says after speaking to them today. Your Charlie is a very handsome boy! 
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Post by Victoria and Allison on Dec 16, 2014 10:09:52 GMT -7
Thanks for more very helpful info!
HEAT/ICE
Do you think moderate heat and or ice near the site of injury of the back [the sacrum in this case] is helpful? If so how often and for how long?
MASSAGE
Also, do you think gentle massage on the sides of the spine but not touching it, and on legs and paws is helpful??? Again how long and often?
NSAID/STEROID DOSAGE
I want to discuss with my vet giving nsaids and steroids now before the 12/22 appt with the specialist. Can you give me a dosage range for each to discuss with vet so that I know the RX I may get will be in a acceptable range so time is not wasted? Anywhere specific I can read about pros/cons of Nsaids vs steroids for spinal inflammation/IVVD/DM?
Update: Charlie still not moving on his own- perfect 'crate rest'! He was on his pillow from 1pm
yesterday until 7am this morning. That is when I had help and we got him out and he did walk
and peed and poo'd which looked normal. He went wild when he was carried yesterday so we felt that was really bad for his back to be fighting and squirming in mid air so we are letting him walk only outside to eliminate. He's eating less but eating and drinking.
Thanks!
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Dec 16, 2014 19:39:04 GMT -7
It is better to have the right pain meds on board to address pain. I would avoid any touching of the back so no ice, no heat. No massage. Waiting til 12/22 for a vet visit is too long. Inflammation in the spinal cord needs to be addressed now. The longer nerves are pressured with swelling the more damage to them can occur. As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. 1. Pain caused by the tearing disc & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails scuffing floor 4. Paws knuckle <---- Charlie is here5. Legs do not work (paralysis, dog is down) 6. Bladder control is lost 7. Tail wagging with joy is lost 8. Deep pain sensation, the last neuro function All about NSAIDs and steroids to get inflamamtion down and how they work with IVDD: www.dodgerslist.com/literature/healingsweling.htm |
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Post by Victoria and Allison on Dec 16, 2014 21:15:55 GMT -7
Thanks!
Specialty hospital ER vet that we saw the other day refuses to administer nsaids or steroids saying if we choose the wrong one you have to wait 7 days to switch!
I did call and found there was a cancellation so we see the board certified ortho tomorrow 11am. I know they are going to want either mri $2500.00 or ct scan $2000. And maybe take spinal fluid a vet guessed today. Any opinions? Is there anyway to avoid having to pay that now, since it doesn't even put one dime into treatment in case he needs surgery? Can I reasonably insist on nsaids/steroids first?
Charlie was worse today. When we took him out for pee 4pm he was almost totally knuckeled,
and really spread legs wide while peeing. Then he walked a bit on his own but when we helped bring him back paws totally knuckled under again.
He has also been panting some of the day. I'm on my way now to pick up gabapenten. Vet forgot to explain how/when I give it. I just gave Charlie his
85 lbs
150 ml tramadol [2x's a day but allows 3] When can I give him his first
300ml gab ?x/day
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Post by Pauliana on Dec 16, 2014 22:09:43 GMT -7
Hi Victoria!
They usually only do an MRI or CT scan prior to surgery since the dog has to be anesthetized and they normally go right into surgery afterwards since they use the MRI or Ct scan to see where the disc problem is..
You can insist that surgery is not an option and you want medical management.. or conservative treatment.
Gabapentin can be given at the same time as Tramadol or as soon as you read this. Next time you can give them at the same time.. They work very well together! The bottle should have the instructions..
Charlie is adorable!
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Post by Victoria and Allison on Dec 17, 2014 17:47:08 GMT -7
Help please! Have difficult decisions to make and I would so appreciate some feedback.
Saw the vet, not the board certified but thankfully this one was on the dodgerlist of recommended vets so I felt comfortable right off.
PRELIMINARY DIAGNOSIS
He said he believes, without an MRI, that Charlies condition may likely be Lumbosacral Stenosis and Cauda Equina Syndrome. This is a narrowing of the vertebral canal near the sacrum near where the hips join the back where lots of nerve endings come together. He said there is bone instability in that area. He said it is one form under the umbrella of degenerative myelopathy. I asked if this was better or worse than IVVD and he said worse. He said most dachsunds have herniated disks and that the material that comes out of those disks causes pressure on the spinal cord and nerves. He said surgery for that condition is more often successful because the debris is removed and the pressure is relieved.
CRATE REST
The vet said that crate rest is an option but only if Charlie does not get worse.
SURGERY
He said for Charlie surgery could mean usually only minor improvements because it is hard to make the area stable, so usually they only fuse a vertebrae or two and there is also scaring as a result of the disease and that can contribute to more narrowing of the canal.
He said there could also be a tumor or infection or something else and we would not know without an MRI and spinal tap under anesthesia.
ANTI-INFLAMMATORIES
He said that studies show that steroids and anti-inflammatories do not significantly reduce inflammation and that their primary accomplishment is pain relief. He said that it is the crate rest that reduces the inflammation by not causing further assault and letting the area rest and heal, where possible.
WHICH MEDS?
So my first challenge is whether to give steroids or Rimydl The vet said I could choose.
Rimydl (75 mg every 12 hours. Charlie is 85 lbs.) is not as successful in reducing pain but he said it is close and it does affect the kidneys. Charlie last year showed stage 2 kidney disease BUT last week ALL his blood and urine values were normal. I had a dog with disk disease many years ago and he did NOT get relief from RImydl but did with prednisone.
He said there could be slightly more success in reducing pain with prednisone (20 mg 1x daily)but he said it would be close. He said he preferred Rimydl because of the possible harm it could cause the kidneys though it did not sound dramatic. The second downfall is that Charlie would have to urinate much more and so he would be getting up and doing so walking (remember he is 85 pounds) and this would reduce his crate confinement during that time.
As you likely know you can’t just switch between NSAIDS and sterioids and you need a 7 day rest between the 2 so I have to make the right choice.
TIME LIMIT
He said if Charlie did not improve within 48 hours of this medication that I should bring him back to consider surgery.
We all know that no one can predict outcomes but there are probabilities. Surgery doesn’t sound dramatically promising. I definitely want to try the meds but WHICH ONE? If I choose the weaker one that doesn’t help, the narrowing could get worse and Charlie could lose ground and he may need surgery. May I please have some feedback. THANKS.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 17, 2014 18:18:03 GMT -7
I wish I could help you more but the only disease we know well here at Dodgerslist is IVDD. I'm not at all familiar with the disease the vet suspects. It sounds, though, that the vet feels that an option other than surgery for what Charlie may have is the same as the conservative treatment for IVDD and I can tell you about that.
I completely disagree that NSAIDs and steroids do not reduce swelling and that their primary function is pain relief. But of course, I'm not a vet and that's based on my experience with IVDD and what I've learned about that. With IVDD, the swelling presses on the nerves of the spine and causes pain and possible nerve damage. The anti-inflammatory reduces that swelling, thereby helping with pain. But its main purpose is to reduce swelling and inflammation. Then pain meds are given to help with the pain until the swelling is resolved. And crate rest for a full 8 weeks to give the damaged disc time to heal and form scar tissue.
Steroids are a stronger anti-inflammatory that NSAIDs. And Dexamethasone is a stronger steroid than Prednisone. My Jeremy was given Dexamethasone for his last IVDD episode and it did a very good job of reducing the swelling in just a few days. No matter whether you choose a steroid or a NSAID, please be sure the you ask the vet if Charlie has any medical reason not to take Pepcid AC to protect his GI tract. If there is no medical reason not to give the Pepcid AC, then do get it board. You would have to check as to the dosage for a dog of Charlie's weight. We recommend giving it 30 mins. before the anti-inflammatory and then every 30 mins. thereafter [error - should be every 12 hours thereafter] for as long as the dog is on the anti-inflammatory. Also the anti-inflammatory should be given with food.
Here's more info about Dexamethasone - and you can look up Prednisone and Rimadyl here, too: www.marvistavet.com/html/dexamethasone.html
As for a 4-7 day wash-out period when switching between a steroid and NSAID, if a vet feels there is a medical necessity for the switch, it can be done without a wash-out period if Sucralfate is also given, along with the Pepcid AC, to double protect against the side effects. So a switch can be made with double protection of the GI tract.
Two days isn't much time to give it until you see improvements. With IVDD, it can take 7-30 days for the swelling to go down.
Possibly one or more of the other moderators can give you more input on this. My prayers are with you and Charlie as you face these difficult decisions. |
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Dec 17, 2014 20:40:34 GMT -7
Victoria, as Marjorie noted the only disease we feel we have good information to share with you is that of intervertebral disc disease (prematurely aging discs). You will need to do some research and self educate on CES. Dr. Nancy Kay, DVM, ACVIM has hit it on the nail. We'll need to be self educated so we can team up to work with our vets or know when to hire the right vet. "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!" www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdfDo your own self education as well on steroids which are the strongest class of anti-inflammatory drugs VS non-steroid anti-inflammatory drugs (NSAIDs) Google and be assured that these drugs ARE used for their anti-inflammatory properties. Anti-inflammatories will get the painful swelling down over the course of 7-30 days. Who wants to wait that long to get pain relief? Pain relievers on the other hand when properly prescribed (combo, mgs and frequency) will mask pain within the hour and keep pain at bay dose to dose. I would still seek out a board certified vet (neurology ACVIM or ortho ACVS) for a confirmation diagnosis. Do you still have the appt with the ortho on 12/22? CES is not a common disease. It may not be possible that a general DVM vet will know CES in detail that a specialist would. A specialist consult also so that you have the correct anti-inflammatory drug on board and appropriate pain meds that a general DVM vet may not be comfortable in prescribing. The specialist needs to see that X-ray taken 12/13 to aid in his diagnosis of what is causing the pressure (bone, disc, tumor). Basically what I quickly read the “tunnel” though which the spinal cord and relevant nerves pass will narrow as a result of abnormalities in the bone area, abnormal intervertebral disc, tumor or arthritis. The pressing on the nerves causes the pain. As swelling takes place more pressure brings the possibility of loss of nerve function. “Nonsurgical treatment: If the condition is mild, dogs may be treated with strict rest for 6 to 8 weeks. Anti-inflammatory medications such as prednisolone are given. In many cases, this can relieve the symptoms. However, when the dog becomes more active, the symptoms can return.” www.peteducation.com/article.cfm?c=2+2084&aid=456
If you have a diagnosis and it is a good one, which calls for trying conservative treatment, then we know about how to do crate rest with good information to share with you. |
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Post by Victoria and Allison on Dec 17, 2014 22:51:05 GMT -7
Thank you Marjorie and Paula! Your feedback is INVALUABLE and offers the very important support that helps me keep going for Charlie! Did I read it correctly Marjorie, you administer famotadine 'every 30 minutes' or about 24 pills every 12 hours? BTW thanks for reminding me about famotadine! I gave Charlie one 30 minutes before his first inflammatory med tonight. I selected prednisone (vet said that or Rimydl) because his tentative diagnosis of CES is very serious and painful plus I want to give him every chance of improving if possible. Charlie is beyond 'the mild symptoms' of pain and stiffness but he has not yet lost his ability to control his bladder and elimination. I don't know why they switched doctors on me, I guess because I didn't want to wait until 12/22. The one we saw was on the dodgerlist as recommended. The facility is California Veterinary Specialist. They are one of the most expensive specialty hospitals in the State. I no longer have the 12/22 appointment but I can still ask for the board certified vet in the future. I totally agree about being a self-educated captain of the ship! Which is why I love your site. First, Charlie's diagnosis is not final. He still may have IVVD or some form of Degenerative Myleopathy or a tumor. But his symptoms are consistent with CES. I'm encouraged reading tonight about a new treatment that has not yet been mentioned: Seen at: www.veterinarypartner.com/Content.plx?P=A&C=20&A=3457&S=0"Recently, preliminary research studies have indicated that the anti-inflammatory effects produced by injecting cortisone drugs into the lumbosacral spinal canal may be as effective as surgery in some dogs. These injections are touted for the majority of cases, in which signs are mostly pain and stiffness.... The treatment approach is to start with medical treatment and leave surgery as a last resort if there is no improvement or if neurologic signs are developing. That’s more the case currently than ever before now that corticosteroid injection is an option... Dogs with mild signs have a good prognosis as they can be medically treated. Severely affected dogs, including those whose nerve root compression is so severe that urinary or fecal incontinence has resulted, have a poor prognosis as most such dogs do not become continent again, even after surgery. However, surgery or epidural cortisone can relieve pain and improve quality of life." Date Published: 5/3/2013 1:28:00 PM Again Charlie does have neurological signs of knuckling under, crossing legs and weakened rear-end control, but at least he is still continent. BTW, I just received the doctor's write up. He said "We discussed LS (lumbar-sacrum) instability and cauda equina syndrome as likely but also discussed intervertebral disk disease. I advised that MRI imaging would be necessary to confirm diagnosis." |
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 18, 2014 6:19:43 GMT -7
I'm so sorry for that error, Victoria! I meant to say that Pepcid AC should be given 30 mins. before the anti-inflammatory and then every 12 hours thereafter for as long as Charlie's on the anti-inflammatory (2x/day).
What was the dosage of Prednisone that was prescribed? Also, be sure to advocate strongly for pain meds for Charlie. As I mentioned, the Pred can help with pain by reducing the swelling but it can take 7-30 days for that to happen so Charlie needs something to address his pain now. His pain should be brought under control today, within one hour after taking pain meds, and kept under control under all swelling is gone and pain has stopped. The vet will be calling for a taper at some point (did he discuss that with you?). At that time, the Pred will start to taper off and pain meds should be stopped so a test for pain can be made to see if swelling has resolved. If not, Charlie would have to be put back on the original anti-inflammatory level of the Pred.
Please let us know the dosage of the Pepcid AC and Prednisone and frequency given, as well as any pain meds prescribed today.
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Post by Victoria and Allison on Dec 18, 2014 9:01:48 GMT -7
Thanks, again! Regarding prescribed dosage and what I read about Cauda Equine
85 lbs
Famotitine: vet said 10 mg tablet every 12 hours Can I give with piece of meat so Charlie will take this?
Prednisone: 20 mg tablet one time daily for 7 days then one every other day
Tramadol: 3 tablets of 50 mg. every 8-12 hours as needed for pain
Gabapentin: One 300 mg. capsule (gelatine cover instead of tablet) three times a day
Questions: Can I give famotidine with some meat so Charlie will take it? I do this with ALL his pills.
Do I always have to wait 30 minutes after famotidine to give other meds? vet said it will already be in system.
Can I give the pred, tramadol and gab at same time? And with food, I know the pred should
be with food, right? At meal time?
THE DISEASE
I am very concerned about pain control as I know dogerlist members all are.
If Charlie has CES he is in for a very rough ride. My understanding:
The lumbar sacral area that is affected is where ALL the spinal column nerve endings meet so his pain is compounded by how many nerves are affected.
When I want to learn about a disease I go to the human forums to see what patients
report. I found their overwhelming complaint is excruciating pain and most of the posters said they cannot keep it under control most of the time.
I am hopeful that maybe Charlie has not had a lot of permanent nerve damage and that he
can rebound and NOT live a life of agonizing pain - which I will not allow.
He IS better this morning! Also some good luck. I ran into a local young man who works at my market. He needs work and can come most evenings to my house at night and help Charlie go outside to urinate so I'm covered mornings, early afternoon and most evenings.
Because prednisone causes excessive urinating and I can't help Charlie myself, do you
think I should look into a catheter or expressing so I can help him when no one else
is around?
Sorry, I don't mean to hog your forum. I know there are so many wonderful pouches who need your precious help too!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Dec 18, 2014 10:27:23 GMT -7
Victoria, famotidine does not require an empty stomach so it could be given with food. It lasts for 12 hours in reducing stomach acids so that is why it is given 2x/day. Preferable is to give it 30 mins before Pred because pred increases stomach acids. Extra protection give Pred with a meal. Pain meds can be given on any schedule with Pred, with famotidine.
So if this is disc related.... actually IVDD or CES due to a bad disc....the 100% STRICT rest is to let the disc heal.
I would discuss the pros and cons with your vet about cathing a dog who has bladder control.
Instead can you set up an area inside his recovery suite that he can pee and poop in. Can you store a piece of soiled pee pad, piece of peed on sod in a baggie, would be good if you can find another dog's pee.. For inspiration to mark and pee, set the "soiled piece" on a pee pad right outside his recovery suite. Will he be of the mind that is is OK to pee on the pee pad?
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Post by Victoria and Allison on Dec 19, 2014 11:11:37 GMT -7
UPDATE:I think there has been substantial improvement already.
Yesterday Charlie did not knuckle under or cross legs. He was weaker than normal but made it in/out. He even lifted his leg to pee! I didn't encourage that because I think you would not think that is good for him but he holds his pee/poo until he can go outside. He won't go inside, never would. We do put a towel under his belly as a sling to take weight off his legs/back when we bring him to the yard. His bed is the other side of the door. Honestly I don't think there is an alternative that will work.
Today! Wow! He got up on his own off his bed which he hasn't done since this started about 12/13 (he's been motionless as if he was paralyzed while inside the house!). Today there was No knuckling under. No leg crossing. And this is the first time his tail raised 1/2 way up instead of hanging lifeless for a week. He tried to prance in the yard as he was looking for a place to pee and we stopped him but I was laughing to myself with glee. He started his boxer dance at the door to go back in, alternating his front paws - this was not encouraged. He has been so stoic and immobile and to see a glimpse of his happy side is quite a turn around! He is sitting down more easily and he is keeping his head up while inside and is more interested in what is happening.
I know that activity could bring the problem right back and that he still needs 'cage rest'. But for today a big "Yah Hoo! And thanks ever so much Dodgerlist moderators for helping us get to this point!
The specialty-hospital vet wanted to know by Monday if he was getting worse or better. He prescribed 20 mg prednisone for only 7 days then taper off. Isn't that way too soon? Don't you suggest that when there is a tapering of steroids that pain meds stop to test for inflammation? Any advice?
Also, he hasn't had a bowel movement for about 2 days. Remedy? THANKS!
The vet said he doesn't think steroids are effective after a few days but didn't think it would be harmful to
extend the period if I wanted. (Seek feedback on this issue please.)
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Dec 19, 2014 12:06:21 GMT -7
Victoria, so glad to read your good news this morning. Vets have to guess when they think all the swelling in the spinal cord is gone. It is prudent to call for a taper in 7 days to see if their guess is correct. No one wants to use these powerhouse meds any longer past the benefit stage... as they all have side effects. To have a clear picture on the taper the pain meds are also normally stopped. With the holidays and vets closing you and your vet will want to have a plan B for meds so you need not go to expensive ER if you see any hint of pain arising but instead can wait til your vet is open again. We, of course, have our fingers cross you will see no hint of pain allowing the pred taper to go to completion. Rule of thumb is: pain = swelling = more time on anti-inflammatory, pain meds and Pepcid AC needed.Tramadol can be constipating. Pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. The amount of water in the diet makes all the difference.
--To loosen the stool, add equal parts water to each kibble meal along with a teaspoon of plain canned pureed pumpkin 1x a day. Our 20 lbs doxies take 1 teaspoon. You will have to come up with an amount for your 85 pound Charlie.
-- To firm up the stool add 1 teaspoon pumpkin 1x a day to kibble and no extra water.
Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potoato. |
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Post by Victoria and Allison on Dec 19, 2014 12:20:24 GMT -7
Paula, Marjorie and Pauliana and for all the fur mom's and dad's holding out hope:
I just gave the good news to the specialty vet. He said that the news of Charlie's progress 'made' his day. He said Charlie's recovery far exceeded any of his expectations and that "THIS IS JUST A REMINDER OF THE POWER OF THE ANIMALS TO CURE THEMSELVES AND THAT THE PROFESSIONALS SOMETIMES NEED TO JUST GET OUT OF THEIR WAY".
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Post by Victoria and Allison on Dec 19, 2014 21:58:03 GMT -7
Paula, Charlie actually liked the pumpkin!
I will get my vet's opinion but I wanted dodgerlist feedback.
Charlie is acting very normal, even more this evening than earlier.
His tail is wagging, no neuro signs except some weakness and stiffness inn
rear legs that I have seen before the episode.
In your experience, should Charlie still be crate-confined for 8 weeks?
Should all the pain meds be given until the tapering period?
Should I even ask the vet to extend the 7 days for pred plus tapering?
By the way, the vet said today that Charlie has instability at the lumbar sacral area and for the rest of his life (he thinks 3 or 4 more years cause he's 12 and big), he will have to have limited activity: no mile walks, running, rough playing. He is pretty sedentary so that will be OK.
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 20, 2014 6:08:46 GMT -7
Since IVDD is a possibility, yes, you would need to treat this as IVDD and not take any chances of further damage to the spine. So the full 8 weeks of strict crate rest would need to be done to ensure that the damaged disc has healed. What you may be seeing now in the improvements that you've seen is that the anti-inflammatory has gotten that swelling down so it's no longer pressing on the nerves of the spine. That doesn't mean the damaged disc has healed yet. It does take 8 weeks to heal the disc and allow scar tissue to form. Too much movement before the disc has healed and the disc can re-tear and you'll be back to square one or cause more nerve damage to the spine. If Charlie were to re-damage his disc, the 8 weeks would have to start all over again. Yes, I would continue to keep him comfortable by continuing to give him the pain meds until the taper of the Prednisone starts. At that time, the pain meds should also be stopped so a good test for pain can be made. A period of 7 days before the start of the taper of the Prednisone is usual. Hopefully, the swelling will have completely resolved by then and all meds can be stopped. If not and pain does return upon the taper, then the Prednisone will need to be returned to the anti-inflammatory level. It can 7-30 days for all swelling to resolve so it's not unusual for the first taper to show a return of signs of pain. We're keeping our fingers crossed that Charlie will have a pain-free taper and can stop all meds. Charlie is doing great - keep up the good work! |
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Post by Victoria and Allison on Dec 20, 2014 17:29:29 GMT -7
Lessons learned. Charlie got up from his pillow today and started rushing towards me because I opened the fridge. If you recall, he's been pretty inert for over a week. I started to say, "No!" but it was too late. His weak legs gave out on the slippery tile floor and he splayed out and fell down. He lay there for about 5 minutes. We were both stunned. I got his pen round his big pillow bed, slid him toward the pillow which he got on top of and locked him inside.
He's been there for a couple hours. He looks more relaxed now, on his side which he does when he's feeling better. Hope there are no repercussions.
Got it, THANKS!!!
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Post by Pauliana on Dec 20, 2014 20:50:46 GMT -7
Hi Victoria!
Glad Charlie is now resting in his pen after his slipping and sliding accident earlier. Hope he is ok too.
Thanks for keeping us posted..
After crate rest is over, it would be a good idea to get rubber backed carpet remnants to put over the slippery floors so he could have more stability.. I have some scattered over the hardwood floors here to help keep our Tyler from slipping.
Will keep him in my thoughts and prayers..
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Post by Victoria and Allison on Dec 24, 2014 22:25:47 GMT -7
Charlie was doing so fantastically and he had improved so dramatically I really thought we got lucky and bit the bullet on what can be a very painful condition in the sacrum where all the nerves meet at the spinal cord. As of Monday he was happy, his knuckling-under had stopped and he gained strength in his rear legs.
Yesterday that changed. It was the last day of his full-strength sterioids and pain meds.
He was nauseous, drooling and vomited twice and had some soft poop. I attributed that to all the meds plus giving him renal canned cat food to get the meds down (he has CRF but values have been normal). I thought the symptoms were gastro and would go away with the elimination of pain meds, canned food and with alternative days off prednisone.
But today again Charlie didn't want to move all day. He did eat his meals and drink
water. No drooling. No vomiting or soft poop. On the one trip out he walked OK with no neurological deficits though he just stood for some time and then shook himself which can be a mechanism to readjust so he can move but that's just a hunch. I also saw him lick his front paws and a back leg yesterday and today but if that is pain coping it could be related to his stomach or his back. It is disturbing especially because when he was at the height of his back episode he did not want to get up at all then. You may recall he had a slipping incident 4 days ago. He has been penned ever since.
I'm hoping he'll improve tomorrow and that his tapering period will be a success but we've definitely hit a bump in the road.
Any feedback appreciated. I'll just add that he went out just now to pee/poo and did fine.
Merry Christmas and Happy Holidays all!
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Marjorie
Moderator~
Member since 2011. Surgery & Conservative
Posts: 5,724
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Post by Marjorie on Dec 25, 2014 6:43:55 GMT -7
Nausea, vomiting and soft poop are all red flags signs of GI distress, Victoria. You need to immediately let the vet know about this. Has he had the renal canned cat food before or was that just started? It's always best not to start any new food or supplements while on meds as then it's difficult to tell whether it's the new food or side effects of the meds. Have you been giving him the Pepcid AC twice a day? Sometimes Pepcid AC isn't enough and with the signs of GI distress that you're seeing, Sucralfate needs to be given as well as the Pepcid AC. Please speak to your vet this morning about adding Sucralfate to heal any damage that has been done to Charlie's GI tract. Hopefully, the vet has an emergency number where he can be reached today. If not, this is serious enough that you should contact an emergency pet hospital and consult with them as GI tract difficulties can worsen quickly and he needs to be started on Sucralfate today. Not wanting to move all day could be, as you said, due to pain from his stomach or from his back. If it's pain from his back, that would mean there is still swelling. Did you start the taper today or yesterday? When did the not wanting to move start - the day he was vomiting or the day the taper started, if it did? I would also discuss this with the vet or emergency vet today to get their input as to whether the taper should continue at this point. With the addition of Sucralfate, Charlie should be able to continue on an anti-inflammatory dosage for a few more days. Pain = swelling = more time on all meds. However, as said, the pain could be from the GI distress. Please also keep an eye on the licking. Watch that it doesn't turn into obsessive biting or chewing. It could be neuropathic pain. Everyone has experienced numbness or pins and needles tingling in your legs when sitting in a bad position for too long a time. Charlie could be feeling abnormal nerve sensations that are mild pins and needles that can progress to quite painful burning, on-fire feeling that makes them bite to stop the pain. These are abnormal signals coming from nerves. You would need to stay on top of observing for any more signs of chewing on body parts as this can lead to death. If you do see obsessive biting or chewing, immediately put a e-collar on or a lengthwise folded towel and secured closed with duct tape. He's already on Gabapentin, which is given for this type of pain, so hopefully this is not neuropathic pain. I just wanted to make you aware of this so you can be on the lookout for any progression. More info here: www.dodgerslist.com/literature/neuropathy.pdfPlease let us know what the vet says after speaking to them today. Prayers for Charlie. |
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Post by Victoria and Allison on Dec 25, 2014 10:09:10 GMT -7
Thanks again sooo much Marjorie for this valuable info and on a Holiday too!
I called the vet,left a message and expect a call back within a few hours.
The vomiting, soft poop and not moving started the 23rd when he was still on all medication including Pepcid twice daily. It was yesterday that was his first Taper day. He had NO medications yesterday but still didn't want to get up. I think I messed up after reading your post, I should have continued the Pepcid yesterday too, even though he was off meds. I found poop from last night that was mushy and not formed (light colored) so he still had gastric symptoms yesterday as well.
Regarding the canned food, he is back on all his regular food to eliminate that issue.
Today he gets his Prednisone 20 mg once and Pepcid 2x's day. Back off tomorrow, etc.
Hopefully the vet will approve the Sucrulfate.
I have enough prednisone, tramadol and gabapentin to put him back on a full course but do
I have enough signs to warrant doing so? I do see some licking of paws, genitals
and leg but maybe a total of 10 minutes the entire day and usually after eating or settling
after coming back in from elimination in the yard. I saw him look at his rear just now which could be sensations.
Is it at all 'normal' during the tapering period or even later for a dog to experience ANY degree of sensations of pain, tingling, numbness?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,555
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Post by PaulaM on Dec 25, 2014 13:56:35 GMT -7
Victoria sounds like the licking is comfort related, not the obsessive licking biting. When nerves start to repair there can the possibily for some abnormal phantom like signals/sensations as the article Marjorie pointed you to. Do be watchful.
The reason to taper Pred is for the vet to test the waters on resolution of painful swelling. If you are seeing painful swelling you'll need to contact a vet to get the 2nd stomach protector just in case (sucralfate) because it is not clear if Pred or food caused the GI upset. and discuss with t he vet about staying on Pred a little longer.
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Post by Victoria and Allison on Dec 25, 2014 14:51:53 GMT -7
Thanks, Paula and Merry Christmas! How wonderful you still devote your time to doggies in need. The ER vet for the specialty hospital where Charlie is being seen, would not approve Sulcrafate. She said to double up on Pepcid so give 20mg 2x's a day. She said there's 'no sign of ulcers'. This is not the first time I've been refused by vets on this subject. While treating a kidney cat I found much resistance to getting a script for it. Both vets argue famotidine is the drug of choice  I see what you mean about the stomach issue, it could be something completely different than the meds. As far as pumpkin, several days ago I started giving it to him with food for constipation. Now that his poop has been watery to soft, should I discontinue it or is it good for soothing stomach issues? I did see some soft poop again just now. I am thrilled though. He is so happy today! Smiling, standing to get his water in his pen and head up and interested in everything going on. Charlie is definitely feeling better! In fact, he's acting the best today that he's acted since 12/13 when this whole back attack started. While outside for elimination, he had to be subdued several times because he wanted to roll over in the grass and play with the other dogs, etc.. His tail was 'happy wagging', no knuckling. The only possible sign of a problem is that sometimes he keeps his rear legs strided apart a bit wider than normal, especially when peeing, but I think this was happening even before the back incident. I thought it was his age or some arthritis. You may recall the vet said his xrays taken last week showed his hips are 'perfect'. Do you think if this positive trend continues from today on, that I can continue with the tapering? |
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Post by Pauliana on Dec 25, 2014 22:14:41 GMT -7
Hi Victoria,
So happy to hear how well Charlie is doing! It is likely because of going back up to the anti inflammatory dose of the Prednisone.. It is working on the swelling and inflammation while the pain meds are masking the pain.. He's feeling better somewhat because of the meds. I would give it some time but I would ask the Vet how long until the next taper..
Merry Christmas to you and Charlie!
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