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Post by Darlene & Megan on May 27, 2015 8:03:23 GMT -7
Hello - I'm in need of some help. I just rescued a dog who "fell on the ice" in February. She's a little Malti-Poo who weighs only 8lbs and I think she may have been dropped but regardless, she's got big problems. The family who had her took her to the vet when the incident happened but were unable to pay for any treatment and the vet just put her on prednisone. This happened in February so she's been on prednisone for nearly 4 months.
I picked her up two days ago and had her to my vet yesterday where I was informed that surgery was no longer an option and that if it had to be done, it should have been done almost immediately.
She has no feeling in her back legs and drags them. My issue is the pain she experiences. I don't know if keeping her alive at this point is fair to her. My vet suggested I cut the prednisone back and add tramadol which I did last night and again this morning. She doesn't appear to be in pain all of the time but only when it's time for her next dose or she's been scooting herself around. I have someone working on making her a wheelchair. I wonder if once she has that if she will feel better?
Can you please give me your thoughts on this. I see there are a lot of people who give their dogs pain meds but since she's not able to have surgery to have the problem corrected, which the vet thinks is a disc injury, am I making her life worse? My vet also told me that I could have an MRI done but it would cost a lot of money and wouldn't change anything other than telling us exactly what's wrong. I don't have a lot of money but I do have a care credit card I use specifically for my dogs. I'm wondering if it would be helpful to have an MRI done in hopes that alternative treatments could help her pain. Chiropractic or acupuncture, maybe? I'm really torn with this as I don't believe in letting an animal suffer but she seems happy when she's not hurting and she's only 6 1/2 years old. I also have to help her relieve her bladder which she doesn't seem to mind and I certainly don't mind doing.
I want to help her but if it means letting her go, then that's what I'll do. I just don't know and I'm already being judged by others as to whether or not I'm doing the right thing by trying to help her.
Any advice would be sincerely appreciated.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,610
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Post by PaulaM on May 27, 2015 9:03:12 GMT -7
Welcome to Dodgerslist. Dar is that correct? I'm so sorry to hear about Megan's fall. Where xrays taken in Feb to determine if vertebrae had fractured, so suspicion if a disc has torn or ruptured into the spinal cord canal? The only vet qualified to tell you if surgery is a consideration is a board certified neuro or ortho surgeon, not a general DVM vet. What is the dose of tramdol in mgs and how often was it prescribed to give? What was the original dose of prednisone given in mgs and how many times a day. What is now the cut back dose in mgs and how many times per day? Depending on your region of the country, prices vary widely on surgery. This is a very good article to ge the low down on surgery including a link of member reported costs: www.dodgerslist.com/literature/healingsurgery.htm Chiropractic work is not recommended for a dog born with disc disease.
In order to help you more, could you please answer these questions?
☐ While on prednisone the GI tract should be protected. Phrase the question to your vet this particular way:" Is there a medical/health reason for my dog not take Pepcid?" If there is no reason, we follow vets who are proactive against not eating, vomit, diarrhea, bleeding ulcers by giving doxie weight dogs 5mg Pepcid (famotidine) 30 minutes before the anti-inflammatory and thereafter every 12 hours.
☐ Currently can your Megan move the legs at all? or wag the tail when you specifically do some happy talk?
☐ Can she specifically sniff and squat and then release urine.. that is bladder control. Or do you find wet bedding or leaks on you when lifted up and the need for manually expressing the bladder. Are you expressing her bladder and poop so that she stays dry...did you get a hands on lesson Let us know, then if she has bladder control or not. What expressing is: www.dodgerslist.com/literature/Expressing.htm
☐ Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood?
☐ When there is pain or neuro diminishment, dogs can benefit greatly with acupuncture or laser light therapy. These therapies can be started right away to help relieve pain and to also to kick start energy production in nerve cells to sprout. So if this therapy is in your budget, seek out a holistic vet. www.ahvma.org/find-a-holistic-veterinarian/ Look forward to learning more about Megan so we know best how to support you.
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Post by Darlene & Megan on May 27, 2015 9:28:52 GMT -7
Hello Paula, Thank you for getting back to me. Yes, Dar, as in Darlene.
I don't believe any x-rays were taken in February. I asked the mom for the vet name so I could get Megan's records and she said there were really no records. She's not even up to date on her vaccinations. I did have an x-ray taken yesterday and it did not appear as though there were any fractures. It did show a difference in the space between the vertebrae at the top of her back however, which the vet said could be a sign that the disc(s) in that area were herniated.
The prednisone as of Feb 2015 2.5mg 2x/day, as of 5/26 2.5mg 1xday tramadol 12.5mgs 2x/day
her mom gave me is 5mg and she was getting half of that twice a day. The tramadol I have for my Golden is 50 mg and the vet said to cut that into 1/4's and give that to her twice a day. She told me to cut back to one dose a day for the prednisone and give her two doses of the tramadol per day. After a week I was told to cut the prednisone to one dose every other day. We didn't discuss any further than that.
It doesn't appear as though Megan can move her legs at all and the vet didn't was messing with her back legs and felt she had no feeling in them. As she's always on her bottom, I haven't seen her wag her tail so I don't know if that's possible.
As for urinating, she can not squat as she doesn't seem to have any control over her back legs. They seem to trail behind her while she scoots. The family told me she just started dribbling urine when she's picked up. It happens nearly every time now. As for her poop, she has been able to poop but the x-ray showed a lot of poop in her so she's not going as much as she should. I was shown how to express her bladder and have been somewhat successful with that but I have no idea how to get the poop out of her. I'm hoping the link you sent me will show me how that's done. I haven't actually seen her poop but I have found normally shaped poops which makes me believe she is able to somehow lift herself up when she goes. I would think otherwise, they would be caked on her backside. I do find some poop on her and I clean her up pretty frequently.
Up until this morning, her poop seemed normal. This morning I did see a bit of blood in it however. It wasn't bright red but it wasn't dark red either. I've got a sample from a few minutes ago that I plan to drop off at the vets shortly. I don't know if there's blood in this sample, I didn't see any but it may be there.
I did buy a package of laser treatments at the vet yesterday but I don't know if that's the same thing as you're referring to. It only took 5-10 minutes and was done with an infrared light?
I just tried to pick her up and she's trying to bite which is what her family said she does when she's "not feeling good." She's done this before but usually when she needs her pain meds. She's panting a lot as well. I just don't have a good feeling about how she's feeling.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,610
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Post by PaulaM on May 27, 2015 9:59:31 GMT -7
Dar, at this point in time the disc should have healed with scar tissue. However, the pain may well be due to the fact that too much of the disc is still bulging into the spinal cord canal or if the disc had torn, some pieces of disc material are still there aggrevating the spinal cord. The hope with conservative treatment is that a bulging disc or pieces will shrink back or be reabsorbed so as not to inflame the nerves in the spinal cord.
So the choice if the above is the situation is to pursue surgery to have the offending pieces removed. Or to treat medically. Find the very lowest dose of prednisone that keeps the inflammation down to use long term along with the lowest dose pain meds to allow Megan to live a happy pain free life through the miracle of drugs.
The pain meds are obviously not yet right (biting at you!) and maybe the pred needs to be a smaller dose but yet given 2x/day. This will all be an experiment with your giving prompt feedback to the vet as you both work out a doable med program that keeps pain away. Speak with the vet about low doses of Gabapentin another pain med that works very nicely (synergistically) with tramadol.
To understand if Megan has bladder control we need you to do the sniff and pee test. Take her out to the an old pee spot when you know she should have to pee. Does she sniff and then choose to release urine? if YES, then means bladder control is there or is coming back.
Reasons for leaking urine are not expressing often enough for a dog who has no bladder control. Another is a urinary tract infection has developed due to not voiding the bladder fully with a dog who has no bladder control. Overflowing is what is happening, the dog is not peeing. Overflowing is not good as it invites UTIs and can permanently ruin the bladder when nerve function would return. I would get a urinalysis to rule out the need for anti-biotics by bringing in a urine sample for vet to run in his clinic. Poop is not the health issue that expressing for urine is. Poop will all come out on its own. Dogs abhor feces where they sleep... so expressing for poop is to avoid these types of accidents in the crate. Expressing is a new skill to learn. It takes about a weeks worth of expressing practice before you reach the proficiency level needed. That is staying drying between expressing sessions. Expect to start out expressing every 2-3 hours and move up to every 4-6 even 8 hours as you see she stays dry. Often enough and fully voiding the bladder at each session is the goal.
Please do some happy talk to Megan and watch if she then does a happy tail wag.
As long as she will be on pred, do not waste time, get the health OK to get Pepcid aC on board.
Laser light therapy is a cold laser type of treatment of light/energy reaching all kinds of cells including nerve cells.
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Post by Darlene & Megan on May 27, 2015 10:24:26 GMT -7
I just spoke to another vet at my vets office and he too suggested we keep her on the prednisone twice a day and another dose of tramadol until she's more comfortable. Her bladder was showing as quite full in the x-ray yesterday as well. I'll keep working on expressing her bladder. I had blood work drawn to check on everything else as well. I think I am going to go ahead and have the MRI done so that we know what we're working with. I have not had Megan on crate rest as I didn't realize how important that was but she'll be spending time in her crate now. I feel better about the poop issue too. My biggest fear has been letting Megan down by causing her to suffer needlessly if there was no hope of her feeling better. Between you and the doctor I just spoke to, I feel a little more optimistic. Thank you.
I'm going to drop off a poop sample today, I forgot to ask about the Pepcid AC but I'll ask when I get there.
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Peyton
New Member
Life is better with a dog.
Posts: 111
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Post by Peyton on May 27, 2015 10:50:54 GMT -7
Megan is lucky to have you, Dar! She will be getting the care she needs and deserves now, thank goodness. The videos on expressing are very helpful. Like most things, the more you do it, the better you will get - practice! Don't be hard on yourself, and post again soon.
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Post by Debbie Blackwelder on May 27, 2015 10:56:36 GMT -7
Hey Darlene, you are a fantastic person taking in a dog with so many problems. Just something for you to think about here, if you are going to do the MRI be prepared to answer the question, are you going to do the surgery, if needed. I know most surgeons want to do the MRI and the surgery at the same time as not to sedate the dog twice. My pups have had three back surgeries and each time I considered it a miracle surgery. When you take your pup in and they are paralyzed and then you pick them up and they are walking. It's simply amazing. My major concern was the pain before the surgery vs the pain after the surgery. The pain before surgery was intense, then after the intense pain was gone and we dealt then with simple surgical pain which was nothing compared to before. The important thing here is not to make a lifelong decision about Megan's future without knowing all of your options. Give that little girl a big hug from us. She has had a difficult life and deserves a good future. Question: Did the vet not express Megan while you were at the office?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,610
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Post by PaulaM on May 27, 2015 11:24:05 GMT -7
Crate rest is only if there is a susupected current disc episode. There are no meds to heal a disc...that happens only with 100% STRICT crate rest 24/7 only out at potty times for 8 weeks. Then after 8 weeks the disc has healed on the outside with secure scar tissue.
So no crate rest if this is believed to NOT be a current disc episode. The suspected pieces of disc material since Feb 2015 are perhaps the cause of the pain. Due the MRI if you are prepared for surgery to follow in the next hours... the MRI is the planning tool for the surgical procedures.
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Post by Darlene & Megan on May 27, 2015 13:34:09 GMT -7
Thank you all for your kindness and words of wisdom. I'm going to talk to another vet regarding surgery. I'll keep you posted.
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Post by Darlene & Megan on May 30, 2015 20:13:52 GMT -7
Just wanted to update everyone on how my Megan's doing. I've finally been successful in expressing her bladder and she's pooping just fine. I'll be calling the University of Illinois on Monday to set her up for a consultation. My hope, for her sake, is that she still has deep pain sensation and that surgery may help. There are places a lot closer to home that would be able to do surgery should that be an option, but I have limited funds and what I can have done close to home versus having the same thing done at the University, is nearly half the cost and I've read some amazing success stories for dogs who've been cared for at U of I. My vet has tweaked Megan's meds and I've had her on crate rest for a good part of her day. This has been doing wonders for her. She seems much happier and there's been no crying when I have to pick her up. I appreciate everyone's help here and will keep you all posted on our progress. Thank you!
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Post by Pauliana on May 30, 2015 20:52:18 GMT -7
Hi Darlene!
Wonderful the meds are now keeping Megan comfortable. If that changes let the Vet know! I have heard wonderful things about the University of Illinois and their care of dogs with IVDD. Glad you are taking Megan there! Thank you for keeping us posted.. Keeping you and Megan in our thoughts and prayers!
You mentioned her Vet tweaked her meds: What is the current med list including dosages and times per day given?
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Post by Darlene & Megan on May 31, 2015 8:31:09 GMT -7
My original vet had cut Megan's prednisone dose down to 1/2 of a .5 once a day and told me to add 1/4 of a tramadol in the morning and evening. When I called and told the vet on duty that Megan was very uncomfortable, he had me add the second dose of ▲prednisone back in and add one more dose of ▲ tramadol mid day.I think part of her discomfort was the fact that I didn't have her on crate rest and her inability to empty her bladder on her own and my inability to do it for her. I'm looking forward to talking to the folks at U of I and seeing if something can be done to help her. Being so new to this, and hating to see any animal in pain, I was having a terrible time with being unable to help Megan. The day I found Dodgers List was a great day for Megan and I. I don't know where we'd be without all of you. Although I do like my vet, she has nowhere near the knowledge you all do when it comes to this type of injury and I appreciate everything you've done for us. I will let you know what happens next for us.
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Post by Ann Brittain on May 31, 2015 8:47:57 GMT -7
Hi Darlene, I'm glad the vet updated Megan's meds. She cannot heal if she's in pain. Are you also giving her Pepsid to help with stomach upset? Being vigilant about strict crate rest for Megan is imperative. Here is a link to information about how to set up as "suite" for her. STRICT CRATE REST: Please carry her back and forth to her potty area.STRICT means NO laps, NO couch, NO sleeping in bed with you, NO meandering, NO scooting, NO dragging around, NO baths, NO Chiropractor (aka VOM). Please follow all of your Veterinarian's instructions. HOW TO SET UP A RECOVERY SUITE AND SUPPLIES: www.dodgerslist.com/literature/CrateRRP.htm Also she may be uncomfortable because of her bladder not being empty. It's difficult, but learning to express her is important to help prevent urinary tract infections and to help prevent leaking. Here is a link to help you learn the process. www.dodgerslist.com/literature/Expressing.htmGood luck with the visit to the U of I.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,610
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Post by PaulaM on May 31, 2015 10:53:40 GMT -7
Darlene is this now the current med list after your vet tweaked the meds? What about a stomach protector.. is she now on Pepcid AC?
8 lbs prednisone as of Feb 2015: 2.5mg 2x/day; as of 5/26: 2.5mg 1xday; as of 5/27?: 2.5mg 2x/day tramadol 12.5mgs 3x/day Pepcid AC (famotidine)?
How are you doing with expressing now? How often do you express...does she stay dry in between expressing sessions?
Look forward to hearing U of I's assessment with your appointment tomorrow!
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Post by Darlene & Megan on May 31, 2015 16:05:49 GMT -7
Oh, I'm sorry Paula, yes I do now have her on Pepcid AC.
I'm having great success expressing her bladder and we're all happier about that too. I've watched the Dodgers List video and every other one I can find on expressing and I've finally got it. I've been expressing at least 4 times a day and she is staying drier but not always completely dry.
I don't have an appointment with U of I yet, I'm going to call them tomorrow to set that up. I'll let you know when I can get her in there.
And thank you, Ann for the information on setting up her suite. I want her to be as comfortable as possible since she has to be confined.
I appreciate everyone's help and concern.
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Post by Ann Brittain on Jun 1, 2015 8:25:15 GMT -7
I'm glad to learn you're getting comfortable expressing Megan. It is daunting at first, but when you get the hang of it, it's not such a big deal. Plus you'll have less worries about leakage and UTI's. Good job!
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Post by Darlene & Megan on Jun 2, 2015 2:33:51 GMT -7
I took Megan to the University of Illinois yesterday. It was determined by the doctor on duty that she does not have any deep pain sensation. Today she will see the orthopedic department and they will be doing either a CT scan or MRI to she if she has any compression of the vertebrae. If so, she may have surgery to relieve those compressions. The surgeon is going to call me sometime this morning to let me know what will be done. I will let you know what happens.
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Peyton
New Member
Life is better with a dog.
Posts: 111
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Post by Peyton on Jun 2, 2015 5:02:33 GMT -7
Thinking of you and Megan
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Post by Debbie Blackwelder on Jun 2, 2015 7:16:40 GMT -7
Darlene, I know this is not the news you wanted to hear, but things could be much worse. Right now all anyone can give you their opinion. I'm not saying these people are right or wrong, only the good Lord knows what will happen in the end. Megan is strong and if anyone can overcome this, she can. She CAN also have a great quality of life living with IVDD -- no matter whether she regains the ability to walk or not. I am going to leave you with these words:
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Post by Romy & Frankie on Jun 2, 2015 12:29:33 GMT -7
My Frankie went in to surgery with some deep pain sensation. I was told after the surgery he had none. Nevertheless, over a period of months, he slowly recovered. He is now walking with a little limp and can ever run for short periods. I don't think even the doctors can predict the degree of recovery that will ultimately take place.
As Debbie mentioned, even if she does not return to walking she can, with the love and support I know you will give her, have a good quality of life.
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Post by Darlene & Megan on Jun 2, 2015 19:53:21 GMT -7
You guys are all wonderful, thank you so much for all your support. And here's the news of the day. I have my little girl home with me and other than being a little stoned from being sedated for an x-ray, she's as happy as a clam. Of course, being stoned may have something to do with that.
I received a call from the orthopedic surgeon this morning while I was at work. She told me that she felt Megan was fairly comfortable and did not really want to do surgery on her if it wasn't absolutely necessary. She had the x-ray sent to her that my local vet took and then took another. I told her to go ahead and do an MRI or a CT scan if need be but she didn't feel it was warranted just yet. She said she was pressing on Megan's spine where the x-ray showed there may possibly be some damage and all Megan did was tense up her tummy. She [orthopedic surgeon] thinks treating the injury with medicine is a better way to go right now. She told me she was putting Megan on a new medicine and wanted to start weaning her off the ▼prednisone. The new medicine is
[8 lbs] 3x daily, 25mg and it's called Gabapentin. [▼prednisone weaning]
She also said she would write up everything she told me today and send me an e-mail. I'll share any other details I may have missed once I get it. AND, she said I could come pick up Megan today. SO, when I got off of work at 1pm today I left immediately for the 2 1/2 hour drive back down there. But, not before I stopped at one of the best bakeries in town and got a dozen wonderful cupcakes for the doctor and everyone who took care of my little girl.
We have another appointment in 4 weeks, July 2nd, to check her comfort level on the new medicine and if she feels it's necessary, if she doesn't feel Megan is completely comfortable, to talk about the possibility or need for surgery again. If she feels Megan is doing well on the new meds and by that time, the much smaller dose of prednisone, then she plans to fit her for a cart.
As I've said before, the only reason I wanted Megan to be able to walk again was for her sake, not for mine. If I hadn't taken her, she'd have been euthanized by now. I've read about dogs in the past who've been paralyzed and had very happy lives, I wanted to give that to her. If my post last night sounded like I'd lost all hope, it was not intended that way. I was worried sick about her going into surgery.
The doctor today was so knowledgeable and so kind and I know if in 4 weeks she doesn't feel Megan is completely comfortable, she'll tell me and we'll do surgery but for the next 4 weeks, my hair will not be turning grey and my credit card will not be going into convulsions.
By the way, last night they gave me an estimate for the surgery. This was after they determined she was deep pain negative. The surgery would have been to relieve any compression she may have had that may cause her pain. It would have been (and may still be if she feels it's necessary), between $3750 and $4800.
Thank you again everyone, I love this group! Little Megan loves you too!!! (I'm happy as a clam myself and NO, I am NOT stoned)
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Post by Debbie Blackwelder on Jun 3, 2015 6:29:13 GMT -7
Darlene, that was a beautiful post. I admire you so much for picking that precious little girl up and dedicating your time to take care of her. She is so lucky to have found you. Sounds like this new vet is dedicated to helping you meet Megan's needs. Never, ever give up hope that Megan will walk one day.
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Post by Darlene & Megan on Jun 3, 2015 8:00:49 GMT -7
Debbie, I can assure you, I will never give up hope. When we were kids, my brother's best friend was paralyzed with a hockey injury. They told Michael he'd never walk again and although it took a few years and a lot of hard work, he proved them wrong. Megan's going to be my little Michael.
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Post by Ann Brittain on Jun 3, 2015 9:11:43 GMT -7
Good luck to you and Megan. Our Buster had surgery over three years ago. His hind legs were paralyzed for several months following the surgery, but now he can walk. Granted it's wobbly walking but the fact he isn't "perfect" doesn't seem to bother him. If Megan is anything like Buster, you will be amazed by her ability to cope with her condition and get on with her life. We've all been where you are and know how hard these first few days can be. You have a great attitude which is the key to helping your dog heal.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,610
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Post by PaulaM on Jun 3, 2015 9:44:15 GMT -7
Darlene, sounds like you had a terrific consultation with the ortho surgeon! Let us know what the tapering (weaning) dose of Prednisone now is? Does the bottle indicate the last date of giving prednisone is? Or is the ortho thinking Megan might stay on pred at the very lowest dose possible to keep swelling managed long term along with gabapentin?
What about Pepcid AC (famotidine) for as long as prednisone is in use. Pepcid AC is to reduce acids that pred causes.
[8 lbs] Gabapentin 25mgs 3x daily ▼prednisone ?mgs ?x/day Pepcid AC ?mgs ?x/day
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Post by Darlene & Megan on Jun 4, 2015 6:41:03 GMT -7
Paula, I'm going to copy and paste some of the information the vet e-mailed to me after our visit. It includes the medication and the tapering off of the prednisone.
DIAGNOSIS: T3-L3 Myelopathy; Deep pain negative paraplegic Summary and Recommendations: Megan presented to the University of Illinois Emergency Service to pursue further diagnostics and treatment options for her 4-month history of hindlimb paraplegia. We performed a neurological examination on Megan, which showed that she has no sensation in her hindlimbs, or ability to control her back legs or her bladder. Based on these findings, we diagnosed her with a myelopathy, meaning there is a problem with transmission of information along her spinal cord. As we discussed, there are many different types of spinal cord disease, all of which can present very similarly. A likely differential for Megan, given her age and breed, is intervertebral disk disease, a condition where one or more of the intervertebral disks bulges or ruptures, causing compression of the spinal cord. This condition may be treated medically or surgically, but for an animal as severely affected as Megan, surgery as soon as possible after the initiation of clinical signs is recommended. Once an animal has lost deep pain, surgery within 24-48 hours has an approximately 50/50 chance of returning ambulation. Past that time, chances drop to 5-10%. Although we do not know exactly when Megan lost deep pain, we suspect the condition has been chronic due to her 4 month history of being unable to move her hindlimbs. Therefore, even with surgery, her chances of walking again are very low. You have stated that your primary concern is for Megan to be comfortable. Again, both medical and surgical options exist. Medical management includes giving Megan analgesic drugs, as well as resting her. Surgery would be aimed at decompressing Megan's spinal cord, assuming a compressive lesion is identified on CT or MRI. You report that Megan has responded well to limiting her activity at home and starting her on tramadol. She is no longer crying at home, and on our exam does not respond painfully to spinal palpation, aside from mild tensing of her abdominal muscles. We believe she is generally comfortable. Since she is doing fairly well and has been chronically deep pain negative, we recommend continuing with medical management at home. We would like to see Megan back in four weeks to re-evaluate her. If at that visit she is still showing signs of pain at home, we will again discuss surgery as an option. However, if she continues to improve, we can instead measure her for a wheelchair. If she declines before her recheck, please call. In the meantime, please continue to follow the instructions included below regarding medication administration, exercise restriction, and bladder management. We also took spinal x-rays while Megan was here, to look for obvious bony lesions such as fractures, infection of the bone, or bony tumors. None of these were observed, and the only abnormalities were narrowing of one of the disk spaces and some mineralized material within the vertebral canal. These changes can be consistent with intervertebral disk disease, but are not diagnostic, as they can also be seen in clinically normal animals. If Megan does end up going to surgery, we will perform either a CT or an MRI to better evaluate her spinal cord.
Prognosis: Poor for return of ambulation. As we discussed, with her chronic history of hindlimb paralysis, Megan has a very low likelihood of ever being able to walk again. However, we feel hopeful that with time, rest, and a combination of medications and possible decompressive surgery, we will be able to help Megan obtain a good quality of life in a wheelchair.
Discharge Status: Unchanged
Medications: 1. Prednisone 5mg tablets: Megan is currently getting 1/2 tablet (2.5mg) by mouth every 12 hours. We would like to slowly taper the amount she is receiving. However, it is very important not to stop this medication abruptly, so please follow the schedule for tapering below: - Please give 1/4 tablet by mouth every 12 hours for 7 days. (6/3- 6/10) - After 7 days, please give 1/4 tablet by mouth every 24 hours for 7 days. (6/10- 6/17) - After that, please give 1/4 tablet by mouth every other day for 7 more doses. ( 6/19, 6/21, 6/23, 6/25, 6/27, 6/29, and 7/1) - Once the full taper has been completed, you may discontinue this medication. * This is a steroid medication used to treat inflammation. Side effects include increased thirst and urination, increase appetite, dull hair coat, elevated liver enzymes, muscle wasting, or gastrointestinal signs (vomiting, diarrhea, ulceration). Do not give with nonsteroidal anti-inflammatories (NSAIDs). If you notice any vomiting, diarrhea, dark tarry stool, or vomitus that appears like coffee grounds, please contact a veterinarian as soon as possible. DO NOT STOP THIS MEDICATION WITHOUT BEING DIRECTED TO DO SO BY A VETERINARIAN. 2. Tramadol 50mg tablets: Please continue to give 1/4 tablet (12.5mg) every 8 hours by mouth. * This is an opioid drug to manage your pet's pain. Side effects include sedation, agitation, anxiety, tremor, dizziness or gastrointestinal disorders (inappetance, constipation, diarrhea). If you notice any of these, please seek veterinary assistance. 3. Gabapentin 25mg capsules: Please give 1 capsule every 8 hours by mouth. * This is an analgesic for neuropathic pain. Side effects include sedation, anxiety, or dizziness. If you notice any of these, please seek veterinary assistance.
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Post by Debbie Blackwelder on Jun 4, 2015 7:05:00 GMT -7
Hello Darlene, thanks for the post about Megan's condition. I am going to let Paula (or one of the other moderators who have knowledge in this area) look it over and get back with you on the exam since you have been speaking with her about Megan's case. Paula has experience with a dog in a wheelchair and long term care of a paraplegic puppy and I do not.
What I can tell you is never, ever give up hope on the Angel walking again. If you do get Megan a wheelchair, think of it as therapy for her legs instead of anything else permanent. Thank you again for taking in this little girl in her time of need and showing her a life of people who care and love her. Deb
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,610
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Post by PaulaM on Jun 4, 2015 7:21:11 GMT -7
Darlene, thanks for the details on Megan. Getting Megan pain free is the goal. It might be that a very low dose of meds for long term allows her that pain free state and is something to discuss with the surgeon. Or if surgery is a consideration for your family that removal of what is compressing the spinal cord can provide immediate pain relief.
What I did not get from the report is whether the surgeon suspicions this is a new disc episode and the rest is to give the disc time to form scar tissue usually 8 weeks. Or whether the suspicion is more likely an old (chronic) lesion or something still pressuring the spinal cord where the rest would be short such as 4 weeks to try and get inflammation down along with the meds prescribed but not a long rest as there is no disc that needs healing at this point.
As Debbie says, there is always hope that nerves are not so severely damaged that they could self repair in time. In the meantime, getting a cart would allow Megan to enjoy running again and all the activities she used to do once she is off crate rest. When and if walking happens that would then be icing on an already very good cake!
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Post by Darlene & Megan on Jun 4, 2015 7:48:20 GMT -7
Paula, here is more of the e-mail I received. I don't know if it answers your question because portions of it, I don't understand at all. Specifically item number 1 under the heading "Spinal radiographs"
Physical Exam:
General: BAR T: 102.1 °F Pulse: 180/min Resp: 55/min Wt: 3.6 X kg BCS: 5/9 MM Color: pink Refill: <2 sec
Eyes: clear, slight serous discharge OU
Fundic exam: Not performed
Ears: mild, waxy discharge in AU
Oral cavity: no abnormalities noted
Teeth: moderate dental calculus and mild gingivitis
Lymph nodes: all peripheral lymph nodes palpate normally
Heart: no murmur or arrhythmias appreciated. Pulses strong and synchronous
Respiratory system: lungs auscult clear, no crackles or wheezes heard
Rectal exam: No masses, or abnormalities noted.
Urogenital: grossly normal
Musculoskeletal: non ambulatory in the hindlimbs, muscle atrophy noted over the hindlimbs bilaterally
Neurological: mentally appropriate with normal cranial nerves. Absent CP's in hindlimbs (CP's in forelimbs normal),
paraplegic, deep pain is negative in both hindlimbs, hyperreflexic in hindlimbs, withdrawals are normal in all four limbs.
Skin and hydration: hydrated, no skin tenting or sunken eyes
Abdominal palpation: Soft, non painful. No organomegaly palpated.
Pain Assessment scale (0= no pain or discomfort , 10= highest intensity) : 2/10
Diagnostic Procedures:
- NOVA profile
PCV/TS 40%/7.0 g/dl
Lactate 4.6 mmol/L (0.435 - 2.93)
Creatinine 0.4 mg/dl (0.73 - 1.19)
- Spinal radiographs: Taken under sedation with butorphanol 0.3mg/k
1) The intervertebral disc space at T12-13 is consistently narrowed on the lateral projections. No evidence of lysis or proliferation is noted. There is subjectively multiple small pinpoint mineral opacities within the vertebral canal just dorsal and caudal to this disc space, which could indicate extruded mineralized discs or artifact.
2) No other abnormalities noted.
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Post by Darlene & Megan on Jun 4, 2015 9:44:44 GMT -7
Thank you, Deb. I just saw your post. I talked to the vet at U of I about Megan's back legs and she said the muscles were atrophied but I could exercise them manually for her. I'm going to do some research and see what else I can do for her. Whatever it is, I guarantee you, I'll be doing it.
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