Loreen's VanGogh 3/27 Conservative - Cardigan Corgi

Loreen, I'm so sorry you have not been able to find a vet knowledgeable about IVDD. Everything pre 3/27 has been most unfortunatley negated: meds and the 8 weeks to rest to allow the disc to heal. In fact, lack of true conservative treatment has caused damage to VanGogh.  More at the end of this post how you can step up to take the lead in his care with the right IVDD health care professionals you hire.

There is still hope though and good hope that VanGogh can get his disc healed and be able to do that without pain. Following Romy's excellent detail and ideas on how crate rest under conservative treatment works will play an instrumental role. Let us know you are doing the 100% STRICT crate rest 24/7 only out at potty times for 8 weeks

The meds prescribed are concerning for two reasons.
1) If pain is still not in control with Tramadol 50mgs 3x/day + Gabapentin 100mgs 3x/day, then the pain meds are not yet right for a 26.5 pound dog.  IF there has still been pain after an hour of the new med dose or pain when moving such as at potty time, then
----- Advocate for the med that works on the specific pain of muscle contractions:  methocarbamol to be added. Where to read more so you know why you are advocating for this med:  to be Rx 3x/day  
MarVista Vet Drug Directory: www.marvistavet.com/pharmacy-center.pml
----- Advocate for Tramadol at the appropriate high dose level than the low 50 mgs 3x/day. The info below is not for you to self prescribe but to be able to bring knowledge to the table to discuss/advocate for VanGogh. We all are laymen, not veterianians and do not know all of Van's health issues, contraindications with other meds, etc. that his vet would know.

The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours

Veterinary pharmacologist Bruce KuKanich, DVM, PhD, DACVCP: "Tramadol is rapidly eliminated from dogs after oral administration. Recent studies are suggestive the bioavailability of tramadol in dogs is lower than originally determined and the dose of tramadol needs to be increased with dosagesfrom 5 - 10 mg/kg PO q 8-12 hours in dogs to maintain similar plasma drug concentrations as those in humans."  New developments in opioids: old drugs and some future directions (Proceedings)" DVM360. Nov 01, 2009 By Butch KuKanich, DVM, PhD, DACVCP
 
2) Use of Chinese herbs are a concern.  I was not familiar with the Chinese Rx's so spent time in looking up each ingredient. Chinese Herbs are composed of many herbs in one bottle/pill, meaning you will need to Google each one to familiarize yourself on what your dog is taking. There can be possible negative reactions between prescription meds and Chinese herbs.
             Very experienced holistic vets will be hesitant to prescribe Chinese herbs when conventional medication are already in use (Prednisone, Tramadol, Gabapentin). The reason is there is no assurance there would not be any interactions with the other medications that could make your dog sick or worse.  All drugs are poisons, all poisons are drugs whether the drugs is from a "natural" herb. 

Chinese Rx: Quick River:
Processed Sichuan aconite main root Jiang huang -
Turmeric rhizome Mo yao -

"Aconite root is a deadly poison- Herbs containing aconitine are toxic to the nervous system. Aconitine excites the vagus nerve and central nervous system first, and then leads to successive inhibition, and finally death because of paralysis" www.tcvm.com/doc/TCVMNews2010SummerR.pdf

"Based on laboratory and animal studies, turmeric may inhibit platelets in the blood and increase the risk of bleeding caused by other drugs. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve® ). "   Prednisone causes extra stomach acids and often carry the adverse side effect of bleeding ulcers when the stomach is not protected with Pepcid AC (famotidine).  So Loreen, IF bleeding ulcers were to develop with use of Prednisone, who wants a drug/herb in the system that inhibits bleeding?


Chinese Rx: KE Bupleurum & Kudzu Clearing
Gan Cao (chinese licorice root) 
      Licorice may increase the adverse effects associated with corticosteroids such as prednisolone and monoamine oxidase inhibitors such as isocarboxazid (Marplan®), phenelzine (Nardil®), or tranylcypromine (Parnate®). Agents acting on serotonin may also interact with licorice.  Loreen, as you can read at the Mar Vista Drug directory entry for Tramadol:  "TRAMADOL is not compatible with other psychoactive drugs such as serotonin reuptake inhibitors .."

Not all vets know every detail about every disease. Some vets are new to IVDD. But you can very quickly get up to speed on just one disease that is very significant to you and Van Gogh.  This page was especially designed for the quick intro necessary in the first days of learning conservative treatment. When pain and meds are right and VanGogh is in comfort inside his recovery suite with 100% STRICT crate rest 24/7 only out at potty times for 8 weeks, then do pursue the rest of your "IVDD 101 readings" to be the  IVDD savvy pet parent VanGogh will depend on during this disc episode and living with you many happy years ahead.  This is the page to bookmark and come back to, start with the gold button on "Conservative Treatment first: www.dodgerslist.com/healingindex.htm

Let us know you have Pepcid AC (Famotidine) on board and that pain is fully in control today.

I am glad that vanGogh's pain is under control. It is great that your vet is so responsive.


I understand why the vet wants to wean vanGogh off steroids. A dog should not be on steroids one minute more than necessary. When the vet thinks that the swelling in the spinal cord that is causing the pain is gone he will start the taper. To have a clear picture on a steroid taper, pain meds are usually also stopped. The owner's job at home would be to assess just how well reduction of swelling is going by observing for any hint of pain. Immediate feedback to the vet about any pain is necessary.


The Rule of thumb for this is:

pain = swelling = more time on anti-inflammatory, pain meds and Pepcid AC needed.


Often a "plan B" with your vet is decided on when a taper is going on so that if the pain happens at night, weekends or holidays when the vet is not open, the owner knows what action to take, what meds to give til the vet can be contacted again. A "plan B" can save an expensive ER trip.

Loreen, you will want to verify you heard correctly. To alternate between a steroid and a NSAID would be an extremely a dangerous practice... possibly deadly for vanGogh. All NSAID packages warn against using NSAIDs and steroid together.  Vets who practice safe medicine look for a 4-7 day washout from the end of a steroid til the start of a NSAID and visa versa.  Do let us know the details of the taper and what the exact name of the med to be alternated is.

Dr. Davidow, DVM, DACVECC explains what is written in many veterinary textbooks about the dangers: "Steroids should never be given concurrently with a non-steroidal anti-inflammatory. Over the years, I have been involved in several cases of both bleeding and also perforated gastric ulcers, some of which required transfusions and/or surgery. Many non-steroidal medications have a very narrow therapeutic dose and the addition of even one dose of steroids can lead to severe intestinal consequences. It is VERY important to look carefully at medication history before starting either a steroid or a NSAID." "Steroid Rules to Live By" Acces Update. Spring 2014. www.criticalcarevets.com/sites/default/files/RDVM_spring_woot.pdf

What dose of Pepcid AC in mgs and are you to give it every 12 hours?

What date is the prednisone taper to start?

I'm very glad to hear that there have not yet been any signs of pain returning during the taper of the Prednisone, especially in light of the vet's very dangerous plan should pain return. Switching back and forth from a NSAID to a steroid is indeed a very dangerous practice.

You mentioned that both the NSAIDs and steroids are delaying the healing process. He's only been on the steroid at this point, is that correct?

Steroids and NSAIDs will not cause a delay in the healing process. Their purpose during an IVDD episode is to quickly get the swelling that's pressing on the nerves of the spine down. It's that swelling/pressure that causes the pain and causes nerve damage. I, too, prefer using natural and homeopathic remedies when I can with my Jeremy. But when he has an IVDD episode and his spine is involved, I gladly allow the vet to pull out the big guns of steroids and aggressive pain meds until the danger of nerve damage is past. Van Gogh hasn't been on the steroid for that long a period of time. Swelling can take 7-30 days to resolve and often times a steroid is necessary during that period of time.

That's what is needed to get the swelling down. As for the damaged disc, it's the 8 weeks of 100% 24/7 strict crate rest for 8 weeks that will heal the damaged disc and allow for the formation of scar tissue. The steroids and pain meds do not heal the damaged disc - only restricted movement does that.

What is very important is to get Pepcid AC on board to protect Van Gogh against the side effects of the Prednisone. The vet is concerned about Van Gogh being on the Prednisone but is doing nothing to protect his GI tract. Please speak to the vet today about adding Pepcid AC 5 mg 30 mins. before the Prednisone and then every 12 hours thereafter for as long as Van Gogh is on the Prednisone (2x/day).

Also the vet has not tapered or stopped the pain meds. Those pain meds are working to mask any sign of pain that Van Gogh may have during this taper of the Prednisone. Keeping Van Gogh on the pain meds during the taper makes it very difficult for you to determine whether there is still swelling and still a need for the Prednisone since you can't tell whether there's pain or not since pain meds are being given. Please speak to the vet today about stopping the pain meds or at least tapering them so a true test for pain can be made. If the pain meds are stopped and no pain returns during the complete taper of the Prednisone, then there would be no further need of any meds.

Prayers for a pain-free taper off of all meds for Van Gogh. Please let us know what the vet says after speaking to him today about the above issues.

We've got our fingers cross there will be no sign of pain on the taper of pred. The taper is a test for pain. Which does your vet want re: pain-masking pain meds to have a true test:
--- stop the tramadol and gabapentin
--- or the backing of of tramadol and gabapentin

The test for pain taper is usually done in a speedy manner. If there still swelling in the cord, then the steroid needs to be back on board a bit longer to get it all resolved. Having pain meds on board during a taper, does not let you know the truth...is the swelling gone or just being masked by pain meds.

To change to a different anti-inflammatory the NSAID require a 4-7 day washout. No washout is double jeopardy to the GI tract...a dangerous sitation that could turn deadly. So as long as vanGogh is on pred, and IF, if he should still have some cord swelling, staying the course with pred is the wiser idea.

The safety in using meds is two fold. A vet who uses them in a safe manner, takes a blood test to verify the health of using any anti-inflammatory med PLUS an owner who has read up on each med to be aware adverse side effects to monitor for.

How long is too long to use a steroid? Carlo Vitale, DVM, Dipl. ACVD: "But what constitutes long-term therapy? More than two months? More than six months? A year? No one really knows, but I would estimate more than three months."

We've got our fingers crossed the pred taper will go to completion, the pain meds will be stopped and you will have an answer that all spinal cord swelling is gone. That means no meds at all are needed, just crate rest to let the disc finish healing.

Update after our visit to the vet yesterday afternoon (4/11/16). vanGogh is doing well, he's walking a bit straighter and we've had no pain incidents while tapering off of the steroids. We have 1 final dose of steroids left, to be administered tomorrow, 4/13/16 (5mg/Prednisone - which he has been on every other day since 4/6/16).

Our plan moving forward is to transition him to NSAIDs, specifically Medicam beginning this Friday, 4/15/16 and administering it 1x/day going forward. We will then begin to taper down the pain meds (tramadol and gabapentin) beginning on Monday, 4/18/16, going from 3x/day down to 2x/day and again monitor closely for pain. The vet is keeping him on the Pepcid AC 1x/day going forward.

The vet feels that we will likely be on the Medicam for another month but hope to be able to taper off of that and the pain meds by the end of the next 4 weeks and then just maintain the Chinese Herbs and acupuncture moving forward.

We have been able to increase the days between acupuncture to 10 now and he's still doing well.

vanGogh remains on crate rest, eating and drinking well only walking at potty times.