Starla's Moe 4/11 surgery GRAD: 5/23-6/6

What is the exact name of the pain med and the steroid injection given last night?

Is all pain fully in control dose to each dose of the pain meds (Robaxin and Tramadol)? These are the signs of pain associated with a disc episode: shivering, trembling, yelping when picked up or moved, reluctant to move much in crate such as shift positions or slow to move, tight tense tummy, can't find a comfortable position, Arched back. Not their normal perky selves. Prompt reporting to the vet lets him know if you are seeing pain that meds still would need some adjustment. Let us know if you are seeing any sign of pain

☐ Are we on the same page about the 8 weeks of the all important 100% STRICT crate rest 24/7 only out to potty for this current disc episode? …. STRICT means No laps, no couch, no sleeping in bed with you, no meandering, scooting or dragging around during potty times. No baths, no chiro (aka VOM).  Carry Moe to and from the potty place allowing only a very, very few footsteps to get the job done.  Fuller details on how crate rest is carried out to ensure you are playing an instrumental role in  his disc being able to heal.  Plus many good tips on setting up the recovery suite:  www.dodgerslist.com/literature/CrateRRP.htm

☐ Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood? Red flag signs of the steroid shot/Rimadyl are not wanting to eat, nausea, vomit, loose stools, diarrhea with blood.  Please do let us know you now have Pepcid AC 5mg 2x/day PLUS  sucralfate on board. 

Excluding an emergency of pain not being controlled or diminishment of nerve functions that require prompt vet help, we have excellent resources for many IVDD questions members have. A well equipped owner is the insurance an IVDD dog needs to protect them during an episode and to live many happy years ahead. Do check out our "All things IVDD" resources How a prematurely aged disc
damages the spinal cord
-- the video clip on "herniation" is very good to watch.  
-- How Conservative Treatment works
Here is the "All things IVDD page:  www.dodgerslist.com/literature.htm  to show you  why "Never give up hope, stay strong, stay positive!"
.

RED FLAG
You are reporting not eating as  normal.  This IS a red flag sign of Rimadyl. Please, do your reading, get on the phone for an ok on Pepcid AC (famotidine) from your grocery store.  Read to understand your dog does not have heart, liver or kidney issues at Marvista Vet website:  www.marvistavet.com/html/famotidine.html  Start the famotidine right away if you can't get in  contact with your vet let him know ASAP of the adverse side effects of not eating and that you have famotidine on board.

The usual dose during a disc episode is Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. Give the Rimadyl with a meal as added protection. www.1800petmeds.com/Famotidine-prod11171.html

I would also advocate for a prescription for sucralfate as added protection to the Pepcid AC. Sucralfate not only “bandages” the ulcer but accumulates healing tissue factors in its bandage; it not only protects the ulcer but actively assists in the healing procss. In order to be most effective, this med should be given:
1.  30 minutes prior to Pepcid AC
2.  Give on an empty stomach at least one hour before feeding.
Read to know which meds do NOT work well with sucralfate and to be fully knowledgable on why you are advocating for sucralfate:  www.marvistavet.com/html/sucralfate.html

FDA does a very good job of telling you all about Rimdayl...important reading:  
www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm196295.htm


PAIN MEDs
The pain meds ARE intended with an IVDD episode to be given on an aggressive dose and frequency so that there is NO pain at all dose to dose. Moe has only you to advocate for him, hire the right vet for his disease.

If your vet is not open to learning what you have learned by doing your readings on our Main Web page about IVDD, then you will need to seek a knowledgable IVDD vet. See if you can't first strongly adovocate with your vet on the phone to get the pain meds right.

Michael Richards, DVM: When pain relievers must be given after an injury has occurred it sometimes takes much higher doses to tamp down the pain and get it under control. It is good to keep this in mind, because many people make the mistake of using low doses of pain reliever initially, hoping they will work. It is probably better to start with high doses and then to cut the dosage if it becomes apparent that lower dosages will work.

Another way of thinking about it [pain] is like a seesaw. You can put a rock on the high end of seesaw and it might not cause it to go down. If you add a second rock that might not move it, either. But eventually you will reach the point where the weight on the upper end suddenly causes the high end of the seesaw to fall. This is how pain threshold works. You really don't feel pain even though something has the potential to cause it until there is enough "weight" to tip over the pain threshold -- then you feel it suddenly.  www.vetinfo.com/dpain.html

Management of pain is a moral obligation and a health obligation.  Pain is a significant stressor, leading to all the deleterious consequences of stress, such as immunosuppression, slowing of the healing process and acceleration of disease processes. Thurman JC, Tranquilli WJ, Benson GJ. Perioperative pain and distress. In: Veterinary Anesthesia. Baltimore: Williams and Wilkins;1996. p 40–62.

Your vet has room to move up in mgs from the low 25mg of Tramadol 3x/day.  
Vets find that adding in gabapentin helps hard to control pain as it works synergisticaly with Tramadol

Discuss a more sane medication schedule than having to give every 6 hours.  Of course if every 6 is what it takes then you do it.  Discuss giving three meds at proper doses promptly every 8 hours (3x/day). All three (gabapentin, methocarbamol, and tramadol) have rather short half lives and that is likely why you are seeing pain before the next dose of meds.  

CAVEAT: It is important to do your own reading about meds so you can participate in discussions. The reason for you to not self prescribe is your vet has responsibility for the health of your dog in meds he prescribes based on his exam, the health history of your dog, how meds interact, not things we or you might know as we are not veterinarians. Vets should be open to treatment options because vet medicine is not a black and white science. And each dog needs a pain medication program tailored to their needs. If you are not satisfied with how your vet handles this disc episode, then there is a need to hire a different vet who is comfortable in treating a disc episode. A specialist (Neuro ACVIM or Ortho ACVS) consult may be in order as they use meds on a daily basis to control pain. Or with your increasing IVDD knowledge gained by quickly getting up to speed,  you can be in a position to hire a new vet if needed.  www.dodgerslist.com/literature/VetchkList.htm

I'm glad that Moe is sleeping comfortably, Starla, but that is not proof that he doesn't have pain. Pain is often seen when being picked up or when taking the few steps allowed at potty time. Also there should be no sign of pain from one dose of the meds to the next as Paula mentioned. You've reported that the meds seem to be working, just not for the full 8 hours. Pain hinders healing and needs to be completely under control. Signs of pain are 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, arched back. If you see any sign of pain, you'll need to strongly advocate for the vet to adjust Moe's pain meds.

Please don't wait until tomorrow afternoon to get Pepcid AC and Sucralfate on board. Contact your vet ASAP. As Paula said, Moe has been given a dangerous combination of a NSAID and steroid without a wash-out period and is showing signs of GI distress by not eating his regular food. Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms and you're already seeing a sign.

Here's more info on laser light therapy: www.dodgerslist.com/literature/healingacupuncture.htm

Please let us know what the vet says about pain meds, Pepcid AC and Sucralfate. Healing prayers for Moe.

Starla, glad the surgery went well.

With the excitement of discharge day in a few days, make sure no question goes without answer. Here's a starter list of questions to which you can add some of your concerns: www.dodgerslist.com/literature/dischargequestions.htm

Good reading which can answer some post-op questions or give you an idea of what you want to know more about: www.dodgerslist.com/literature/surgery.htm

We look forward to hearing when Moe comes home, if he has bladder control, med details and that pain is fully in control at home.

Starla, Moe is doing quite well, already peeing on his own!! The pain meds can cause some nausea. Once the patch comes off many dog suddenly get their appetite back. Thanks for the very good update!

Starla, that post was so very encouraging! Moe is doing great. I would add the pumpkin now. One teaspoon of pumpkin once a day also with soaking Moe's dry food in equal parts water a few hours before feeding will help him. After I learned this trick I do it every day with my four dachshunds. It helps them go to the bathroom regular each and every day and is a good habit to get into.  I actually called the company I purchase my dry kibble from and they told me the same thing.  They said all dry food should be soaked in equal parts water each and every time it is fed.

Pumpkin is a magical fruit - its high fiber can firm up stools and help with diarrhea or loosen the stool to help with constipation. Note alternatives: really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potato. 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.

Starla, wonderful news to hear he is not as wobbly.

Well, if increasing tramadol can control pain, then maybe he does not need a non-steroid anti-inflammatory (NSAID). You can also discuss adding gabapentin back with the tramadol as vets find that combo helps better with pain. What dose did the surgeon say the tramadol could go up to?

Glad to hear Moe is on a roll! Yay! You might want to look through our emergency crate training article for any ideas you like to help him relax for the next weeks: www.dodgerslist.com/literature/EmergencyCrate%20Training.htm

So sorry I have not updated. We are in the middle of building a house, and things have been hectic. I am so elated with Moe's progress. He is still on crate rest except when we are home and he is monitored extremely closely. He had lost 2 pounds, but gained 1 back. The vet thought he was depressed, so he recommended more walking time and time out with us. The vet sais his QUALITY of life was most important. He will be on this for another 1-3 weeks, then we are off crate rest, but we have decided he will still sleep there here on out.

If you did not know Moe had been through all of this, you would not notice that he was any different than any other dachshund. His walking is almost 100% back to pre rupture. He is even able to hike his little leg to pee! Also, he is able to do his little stretches again. I never thought I would get to see those again, but it has made my heart burst with happiness seeing him recovering his little nuances one at a time. He is back to squeaking his little toys again. Oh, and he has most of his back hair back.

We got Moe an orthopedic cave bed. He LOVES it. I just wish he'd figure out how to burrow in the cave, since I know he loves to burrow in the bed with us. Even though he will never get to sleep in the bed with us again (can't risk him rolling off) we will let him lay with us on weekend mornings, which he loves.

This has definitely changed our lives, and we are still coping everyday. The best thing that has come of out this is Moe is on a strict schedule now. He is on a weight loss diet, and no longer free feeds. It's amazing that he eats the minute the food is down. He was so picky before. He also used to spend a lot of time guarding his food from his 5 feline brothers, and his feeding schedule has eliminated this. He is also doing really well with a potty schedule. I just can't stress how happy we are to have our baby back!

I uploaded a couple of Moe into the album, and I'd like to add a few more. Everytime I upload, it is flipping the image. It is correct when I upload. Can you help me fix this? Also, the caption is not appearing in the album. I added it under the part that asked for the caption. Was this correct?