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Post by Nancy & Maisy on Apr 20, 2015 19:22:57 GMT -7
I called Oregon State's small animal hospital today to make an appointment for Maisy in order to have her evaluated for surgery for hip dysplasia. She has been in pain. Long story short, the lead doctor called me back this afternoon and said she looked at Maisy's x-rays and is worried that this is a disc episode and not hip dysplasia (as was diagnosed by the radiologist). She said a lot, but the main point was to get a good neurological exam for Maisy asap. We have an appointment with the same vet that sees Mowgli tomorrow at 10:30 am. Maisy started strict crate rest today at 4 pm, along side Mowgli. I have to laugh, or I'll cry!
Maisy is on Rimadyl, started the evening of 4/18, when the Tramadol wasn't controlling her pain (both prescribed by regular vet) Meds:
[15.6 lb] Rimadyl 12.5 mg every 12 hours Tramadol 25 mg as often as every 6 hours Pepcid AC 5 mg every 12 hours
History: Maisy is 1.5 yrs old on 4/22, purchased from a reputable breeder in Colorado. She's a beautiful 15.6 lb. red and white dapple long haired doxie with one blue eye. Maisy lost her appetite last Saturday, 4/12. I took her to the vet the following Monday, 4/14 when she still wouldn't eat well despite all of my efforts and was yelping at times and acting clingy. The vet checked her back and hips and took 2 x-rays. She felt crackling in the hip area. The radiologist report came back the following day as mild hip dysplasia. He said that though there was some obliquity to the spine on the x-rays and he couldn't read the spine well (per his report), he didn't see disc space narrowing and the spine looked unremarkable. I brought home Tramadol from the vet visit and began giving it and researching hip dysplasia. Maisy improved some, but her appetite has not come all the way back. She ate well and seemed to feel better for the early part of the week and then her appetite began waning again. I called the vet and she said I could increase Tramadol to 25 mg every 6 hours. I didn't see much improvement, so called again Sat. morning. Vet added Rimadyl. Maisy improved greatly on the Rimadyl, in terms of her activity (which in retrospect is not a good thing. Glad she feels better, but she moved around a lot more). I've been noticing that she is pig sitting, with her legs forward of her hips and flat on the ground. This has increased and worsened over the last couple of days. This morning she yelped again. Her appetite is okay, but not "back". She will eat boiled chicken, pnut butter and a certain treat she loves. I had stopped the Tramadol because the Rimadyl seemed to be enough for two days (I'm learning and won't do this again). After the OSU vet called today, I started the Tramadol again. She will eat boiled chicken, pnut butter and a certain treat she loves. Until the vet from OSU called today, I was doing partial crate rest. She went on strict 24/7 crate rest as I hung up the phone (actually, she has been in her crate all day because I was at work the first half and she preferred to be in it after I got home). She has a recovery suite next to Mo's.
Signs of pain: inappetence, yelping and whining occasionally near the end of the Rimadyl's affect, pig sitting (that's what a vet I had once called it in my older arthritic dogs).
I know my task now is to adjust meds until she's pain free and eating well again. I'm wondering whether I should withhold her meds in the morning because she'll have an exam at 10:30. They asked me to fast her after midnight tonight and give water. I don't want to give the Rimadyl on an empty stomach, even with Pepcid on board. I suppose the fasting is in case they want to do an MRI, but I don't want an MRI if this is a disc episode. I will call them and ask. Hopefully the neuro exam will be conclusive one way or another. I can see needing further imaging if it isn't, but would ask for additional x-rays first. The OSU vet said that Maisy's knees were too rotated in the existing x-rays to make them of much value, diagnostically speaking.
Question: Can the vet switch us to Metacam tomorrow without worry? |
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,892
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Post by PaulaM on Apr 20, 2015 20:13:16 GMT -7
Oh gosh Nancy, poor Maisy with a possibly wrong diagnosis. It is obvious that her pain meds are not right. Tramadol can be upped in dose for her 15 pounds if this turns out to be a disc episode. Gabapentin can be added as it works well vets are finding with Tramadol. Disc episodes can be pretty painful with muscle spasms and the med for that is methocarbamol. Switching between NSAIDs or switching steroids <--> NSAIDs requires a washout of 4-7 days. Why is there thought to switching NSAIDs. If this is a disc episode and Maisy's legs are paralyzed, can't walk, then moving to the most powerful of the anti-inflammatory drugs, steroids) to help stop nerve damage is often what vets will choose. It may be the Rimadyl is contributing to GI upset (nausea, not wanting to eat, which can soon lead to vomit diarreah and bleeding ulcers. If Rimadyl is to be continued, then ask for a 2 Gi tract protector in addition to Pepcid AC. Read about sucralfate: www.marvistavet.com/html/sucralfate.htmlSounds like nerves are being damaged that she sits as you describe with legs in front of hips flat to the ground. But you say she can still walk?  To get a good picture with xray or with MRI anesthesia is used. So that is the reason for fasting. If it is determined to be a disc episode, then conservative treatment does not require knowledge of which exact disc is the problem. All discs will receive limited movement under conservative treatment. Discussion of IVDD surgery or conservative as background for tomorrow: www.dodgerslist.com/literature/healingsurgery.htmYou may find this little card to carry with you at vet visits helps to keep all the meds straight as you discuss things with the vet. D/l here: www.dodgerslist.com/literature/MedCard.pdf  We are as anxious as you are to find out what the vet diagnosis tomorrow. |
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Post by Nancy & Maisy on Apr 20, 2015 21:17:39 GMT -7
Thanks, Paula. Yes, sounds like a misdiagnosis and worsened symptoms because I didn't know to crate rest her, thinking it was hip dysplasia. I had read that many dogs with HD do well on an NSAID for long periods of time. I'm just so thankful that the OSU vet thought to call me; she didn't have to and it just shows what a good and caring vet she is. Thanks for the photo; Maisy's legs aren't quite that bad, but yes, that's similar and I'm just sick about it. It really has worsened over the last 24 hours. I think she felt better on the Rimadyl and got over active due to the pain relief and has worsened the disc and swelling. I'm just praying it doesn't rupture. And YES she is walking really well. I've been around long enough to know that it's best to just move forward from here and focus on what's best for her now that I know what to do.
I guess that since the doc we're seeing tomorrow prescribed Metacam for Mo, that he may want to switch Maisy. And I guess there would be no wash out period because they're both NSAIDS. I've also read that Rimadyl is, in the opinion of some vets, more likely to create GI problems and liver toxicity than Metacam, but that opinion can differ from vet to vet.
RE: further imaging. I think I'll just refuse it and proceed with conservative if it's suggested and involves anesthesia. I have never heard of x-rays involving anesthesia, but assuming what you say is true would refuse them. That will be emotionally difficult, but if surgery isn't indicated, then that's the best way to go. I'm even afraid of the exam... Mo was in a lot of pain after his exam because the vet flexed his back, did a gait test, etc. much more pain than prior to the exam. Which leads me to my REAL question: do we need an exam??? If my regular vet will prescribe meds for Maisy (as she has been), could I skip the trip to the neurologist and just get on with conservative treatment? There is no paralysis. She is moving just fine when she moves. She has both bowel and bladder control. This is her first episode. Do I even need to put her through the exam? The only reason I'd be doing it is to get a diagnosis and figure out whether it's spine related/IVDD related. What if I just get on with the business of conservative treatment and don't put her back at risk by attending the appointment?
Actually, I guess we have to do the appointment in order to be able to add Gabapentin, etc. When I called the clinic after hours tonight to ask about upping her Tramadol, the receptionist said Maisy's at the upper limit at 25 mg q 6 hours. It's not her business to tell me that, first of all and secondly, I know that at least 2 mods here have said that their dogs were on higher doses.
Ahem, back to my original point, I would think I'd need to go do the consult and exam in order to get the correct meds. I'm sure my regular vet would recommend the neuro consult and would probably not be comfortable prescribing additional meds without a change of diagnosis. But you can bet that I'll be bringing my non skid latex shelf liner for that exam table tomorrow! OR maybe I'll call my regular vet in the am, explain what I've been told by the OSU vet and ask her if she'll add Gabapentin for us.
Here's a question: If we go to the consult, should Maisy skip her a.m. pain meds so that the vet can diagnose, i.e., if she's feeling comfortable will he be able to make an accurate diagnosis?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,892
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Post by PaulaM on Apr 20, 2015 21:52:35 GMT -7
Nancy even a switch from Rimadyl (carprofen) to metacam is dangerous. Switch from a NSAID to NSAID does require a 4 to 7 day washout. " Pfizer recommends a 5-7 day rest period when changing over to Carprofen or to another NSAID from Carprofen. Aspirin poses an exception due to its strong platelet inactivating abilities so 10-14 days is recommended when switching to Carprofen from Aspirin. Allow at least one week between Prednisone and Carprofen.” from:
www.marvistavet.com/html/rimadyl.html[Sitting like the picture is a sign of nerve damage paralyzed legs due to a disc episode. Since Maisy CAN walk, that sit is due to something else. Your call if you feel you need the eyes and hands of a neuro to determine what is going on. Or to get the right meds on board, a consultation is a good idea. If you can give the last dose of pain med about 6 to 8 hours before the appointment with the neurologist, that should have the meds pretty much out of her system for the exam. |
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Post by Nancy & Maisy on Apr 20, 2015 23:53:03 GMT -7
Thanks, Paula. I'm not sure where you live and I appreciate you replying so late at night.
I don't know how but every time I've read about the wash out, I read that it was only necessary between a steroid like Pred and an NSAID. Thanks for clarifying and glad I asked.
The way Maisy's holding her legs is more like my older arthritic dogs in the past have done before going on chondroitin or an NSAID. She's holding them funny when she lays down as well and I've been told by vets in the past that this can indicate severe back pain.
I'll sleep on this and see what I decide in the morning as to the neuro exam. She's due for her Tram now, so the next dose wouldn't be unti 6 am. That's 4.5 hours before our appointment. I'll see where I'm at in the morning and decide about the meds then. Thank you!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,892
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Post by PaulaM on Apr 21, 2015 7:18:29 GMT -7
Nancy, I'm in the Northwest too but in Montana. Looking forward to your decision of a neuro exam appointment if just to get the right meds (dose/frequency) on board so Maisy can heal in comfort from pain. And to confirm this IS a disc episode and the right treatment of limited movement.
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Post by Nancy & Maisy on Apr 21, 2015 9:02:38 GMT -7
Yes, we're going! I'll just watch and make sure they're very careful with her.
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Post by Nancy & Maisy on Apr 21, 2015 14:00:56 GMT -7
So, still a bit confused as to diagnosis, but we have a probable disc episode with a normal neuro exam (yay!) and Dr. Hicks recommended conservative treatment and prescribed the Gabapentin. He said he thinks Maisy's prognosis is very good, but of course to call or come in if she shows signs of neuro deterioration. He said that her hips are dysplatic looking, but that this will probably never be of any clinical significance in a dog Maisy's size and that her hips certainly aren't bothering her today, so are not the source of her pain. He also said her spine looks fine on the x-rays already taken and to keep a look out for other symptoms (such as GI symptoms) that might explain her pain. Her blood work done on 4/13 was unremarkable. In the meantime treat as a disc episode and manage conservatively. Recheck in 2 weeks.
Meds and instructions:
6 weeks strict crate rest (We'll do 8)
[15.6 lb]
Tramadol 25 mg q6h prn
Gabapentin 100 mg q8-12h prn
Rimadyl [as of 4/18]: 12.5 mg q12h through this Sunday, then stop and watch for pain. If pain is controlled, slowly reduce dosages on pain meds and taper off. Call if pain persists.
Pepcid AC 5 mg q12h
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,892
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Post by PaulaM on Apr 21, 2015 14:25:38 GMT -7
Sounds like good advice from Dr. Hicks to treat as a disc episode and continue with conservative treatment.
Nine days on Rimadyl til this Sunday, makes sense to stop and see if all the painful swelling is gone. No one want to use these high powered IVDD meds past the benefit point. If pain would surface, then likely another try on Rimadyl for a bit longer and then another stop to again test for pain.
So what is the reason that Maisy sits with her legs the way she does....since she has no neurological deficits?. Does it have to do with hip dysplasia?
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Post by Nancy & Maisy on Apr 21, 2015 16:13:40 GMT -7
That's the one question I didn't get an answer for. I've emailed him to ask and I'll let you know. I don't think it's her hips, because he said they aren't clinically significant and aren't uncomfortable.
Thanks for your help, as always!
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Post by Nancy & Maisy on Apr 22, 2015 10:59:57 GMT -7
I added the Gabapentin yesterday and Maisy's pain seems under control. She ate a normal meal this morning; chicken, carrots and kibble! This is the first time in over a week!
Will let you know when I hear from Dr. Hicks re: the pig sitting.
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Post by Debbie Blackwelder on Apr 22, 2015 11:09:33 GMT -7
That is so good to hear - maybe she can heal in peace now with no pain. Way to go and advocate for Maisy, you are her voice!
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Post by Nancy & Maisy on Apr 22, 2015 19:06:55 GMT -7
Thank you. My next challenge: now she's feeling so good that she's a pistol on her potty walks. Oy vey. Even on a short leash, she's trying to jump and run. What to do? I've ordered 2 new crates for resting that will make life a lot easier since I now have 2 on crate rest. Once they arrive tomorrow I can set up one of my ex pens in the potty area and make it small. That might be a good approach. Let me know what you think, please.
I changed my avatar picture so you can see how pretty she is. She was 5 months in this photo.
At the vet yesterday a woman came in with her doxie to see Dr. Hicks as I was leaving. The dog was uncrated and in a bed. The woman was struggling to get her out of the car. He husb was on crutches, so I helped her get the dog into the building. I tried to explain that her dog should be crated and rested and she would only argue that her dog goes ballistic when confined. I said she might need sedation, but crate rest is all that will heal her. I wrote the forum address down for her. I sure hope she uses it! I run into so many owners of dogs with disc issues; 3 at work right now. I always hand out pamphlets and sadly, none of them show up here. They think crate rest is cruel and look at me like I'm crazy and over zealous. It's sad. |
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Post by Pauliana on Apr 22, 2015 20:42:56 GMT -7
Hi Nancy!
Good idea to use one of your ex pens for potty time for Maisy! Thanks for using her picture in your avatar..
She and Mowgli are very lucky to have you.. Alas it is true some people won't listen about crate rest. Thank you for handing out our pamphlets. It does help. We have people that read but don't post, so you likely have reached them more than you know.. That's the hope.
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Post by Nancy & Maisy on Apr 26, 2015 18:06:22 GMT -7
Ug, very mad at myself. Mo got out of his crate while I was washing the car because I forgot to put a clip on the crate. He ran around and had a grand time, I'm sure. He met me at the door when I came in, happy as a lark. So far he seems fine with no signs of pain. I'm really hoping we'll skate by unscathed and plan to make certain this doesn't happen again. We were at 5 weeks yesterday and I hope I haven't undone his healing.
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Post by Pauliana on Apr 26, 2015 21:01:19 GMT -7
Hi Nancy,
Mowgli, you little rascal. Good news he isn't in pain and I hope he continues on as if nothing has happened..
Fingers crossed!
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Post by Nancy & Maisy on Apr 27, 2015 23:48:41 GMT -7
Thanks, Pauliana. So far, so good. I'm hoping we'll get away with this one. 
Stopped Maisy's Rimadyl last night [4-27] and it's looking like it did the job. She ate pretty well today and no signs of pain. I tapered the pain meds to every 12 hours today. Looking good so far. |
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Post by Debbie Blackwelder on Apr 28, 2015 4:42:10 GMT -7
Hello Nancy, usually the pain meds are stopped at the same time as your NSAID or before hand. The only way right now that you can get a clear picture of whether Maisy need's the NSAID further is to know if she is in pain or not. If you give her the pain pills then you might not know if there is painful swelling still in the spinal cord. If the painful swelling were still to remain then you would need to start the NSAID back, asap. This is something you really need to discuss with your vet.
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Post by Nancy & Maisy on Apr 28, 2015 10:38:07 GMT -7
How quickly we forget! The vet's clear instructions to me when we left our visit (and on the D/C notes) were to stop the Rimadyl and then if no signs of pain, slowly taper and stop the pain meds. I just went with it, completely forgetting what I've learned here. I'll e-mail him right now. Thanks!
update: Vet agrees we should discontinue pain meds. I have done so and so far, so really, really good! She's eating well and seems perky; a little too perky at times. She likes to roll when she comes out of her crate and it's tough to stop her. I'm working on it.
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Post by Debbie Blackwelder on Apr 28, 2015 16:29:33 GMT -7
Good deal Nancy, keeping my fingers crossed for smooth sailing from this point forward. I have one pup that loves to roll and I had the same problem with him when he was in his crate. I do remember so well the day I let him out when his crate rest was complete and he rolled and rolled. Keeping you guys in my prayers. Deb
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Post by Nancy & Maisy on May 1, 2015 10:01:04 GMT -7
Maisy continues to appear pain free! So does Mowgli! Both are eating well with no signs of pain, with no meds.
Their nails are getting sooooo long. I would guess that it's best to just let them be that way until crate rest is complete. Thoughts?
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Post by Debbie Blackwelder on May 1, 2015 11:06:20 GMT -7
Hello Nancy, we all know and understand that we have things that need to be done but it's best to wait until after crate rest is over. We want to make sure the damaged disc is completely healed and scar tissue has formed. They will be ok until the grad date of 6/15. I am so glad they are doing so good.
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Post by Nancy & Maisy on May 16, 2015 19:03:31 GMT -7
Maisy's doing very well! No signs of pain since she came off her meds. She tends to worry me by being hard to contain when she comes out to potty; like a loaded spring. I pick her up like in the video, but she always has to give a big wiggle. We're doing the best we can.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,892
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Post by PaulaM on May 17, 2015 7:11:24 GMT -7
Nancy, glad to hear Maisy is progressing nicely off meds with no pain and her normal perky self. All that remains is time to let the disc heal.
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Post by Nancy & Maisy on Jun 4, 2015 20:46:18 GMT -7
Maisy continues to do well with no pain, except her jealousy and aggravation that Mo is out of his crate and well along in his rehab while she's still confined. It's loud around here! Mo's enjoying his freedom and remaining pain free so far. Life is good!
To the ladies of Dodger's List, thanks for all of your wonderful help!
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Post by Debbie Blackwelder on Jun 5, 2015 5:51:14 GMT -7
Nancy, thanks for that update. We are so happy things are progressing nicely and I know you are looking forward to Maisy's graduation date of 6-15. Maybe things will quiet down when Maisy is free.
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Post by Nancy & Maisy on Jun 15, 2015 18:29:48 GMT -7
Maisy graduated today! She's younger and so harder to rehab than Mowgli; full of piss and vinegar, but we do the best we can. First job is to teach her 4 feet on the floor. She's enjoying being out of her crate for her hallway walks! I took Mo to have his very long nails trimmed a few days ago. Even as the groomer explained to her coworker about IVDD and how careful they need to be with him I had to stop her several times because she was moving him in ways that were not good. We've decided that we need to acclimate the dogs to the Dremel and do their nails at home. Sigh. |
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Post by Pauliana on Jun 15, 2015 21:09:18 GMT -7
Happy Graduation day Maisy! You did it! Enjoy your new normal!  |
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Post by Nancy & Maisy on Jun 20, 2015 9:59:46 GMT -7
MaisyAh, the trials of rehabbing a 1.5 year old dog. There is no such thing as slow. I'm using treats for her hallways walks to keep her attention and keep her from running. She's a tightly wound little spring. She escaped her crate this a.m. and zoomed through the house 3 times before I could catch her. I'm hoping for the best. She did very well on a short walk in the backyard yesterday; so much to sniff that she was happily occupied. But I'm thinking her 5 minutes of free time inside this week will have to be on a leash. My biggest dilemma with Maisy is that she'll need to be spayed soon. I had planned on one litter of puppies for her, not be a backyard breeder, but so we could have a puppy or two and allow her to do that, but now it's out of the question. I'm planning on waiting til she's fully rehabbed, but she's due to come into heat soon. It's just nerve wracking. Mowgli
is doing well. He was so easy to rehab and we followed the instructions here for after crate rest pretty much to the T. He's showed no signs of pain, but I do have a question about his gait behind; he's still "bunny hopping", using both hind legs together when he runs much of the time. Does anyone know whether this might mean that he's still having discomfort? I remember the vet saying that this was one of the signs of his bulging disc. I'm asking here first because my guess is the vet will recommend and MRI when I ask him about it.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,892
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Post by PaulaM on Jun 20, 2015 10:39:28 GMT -7
Nancy, Mowgli's gait is a sign that his damaged nerves still have more healing to do and not a sign of a current disc episode. You may want these signs of pain and ensuing nerve damage during a disc episode for your fridge: www.dodgerslist.com/literature/FridgeInfo81907.pdfWith any procedure that requires anesthesia, you will want to be assured your vet and all vet techs in attendance understand the risk. A dog's main defense against further disc damage is dependent upon control over the core trunk muscles – this defense is eliminated with anesthesia. Mark Bush MA VetMB CertSAS MRCVS advises when under sedation " great care must be taken to ensure the patient’s spine is kept in neutral alignment throughout the procedure, and any movements are controlled and kept to a minimum." More on precautions with IVDD dogs: www.dodgerslist.com/literature/IVDDcourse/precautions.html |
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