Yvonne's Charlotte 4/12 Surgery—Newfoundland, Canada

Welcome to Dodgerslist, Yvonne. We're here for you and Charlotte and will help you through this.

Tramadol does work best when given every 8 hours (3x/day) so do continue to give it three times a day. She may be in pain and that may be why she didn't want to come out of the crate to do potty. If you do see signs of pain, the vet has room to move up on the Tramadol dosage and can also add Methocarbamol and Gabapentin. Have no patience with pain as pain does hinder healing.

You're absolutely right about the strict crate rest. Keep the door of the crate closed as when Charlotte starts to feel better, she'll want to move more. 8 full weeks of strict crate rest is required to heal a damaged disc.

In order to help you more, could you please answer these questions?
☐ Let us know you are on the same page about crate rest. The hallmark component of conservative treatment is the crate rest part. With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. That 6 weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form. Super tried and true tips for setting up the recovery suite: www.dodgerslist.com/literature/CrateRRP.htm
STRICT means:
- no laps - no couches
- no baths - no sleeping with you
- no chiro therapy - no dragging or meandering at potty times.
Carry to and from the recovery suite to the potty place and then allow a very few limited footsteps. Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. An ex-pen in the grass is an excellent alternative to minimizing footsteps with the physical and visual to indicate there will be no sniff festing going on! www.dodgerslist.com/literature/slingwalk.jpg
☐ Is there still currently pain - 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, restless, can't find a comfortable position. Ears pinned back, arched back. Holding front or back leg flamingo style not wanting to bear weight, head held high or nose to the ground. Not their normal perky selves. Full pain relief is expected in 1 hour and stays that way dose to dose of correctly Rx/d pain meds.
"There is medicine and there is healing. Healing requires rest and comfort, and all patients should be kept as comfortable as possible. Studies have shown a correlation between less pain and faster recovery from illness, surgery, or injury." Barak Benaryeh, DVM, DABVP. Identifying Pain in Geriatric Patients. Veterinary Team Brief. NOV/Dec 2015.
☐ Why Chiropractic is not recommended for pain for an IVDD dog www.dodgerslist.com/literature/chiropractic.htm

☐ What is the exact dosage of the Metacam? Yes, please include the all-important stomach protector such as Pepcid AC. 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.
☐ Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood?

The unknown is simply too scary a place to stay in. Are you ready to get up to speed on all things IVDD and fight the IVDD enemy? Excellent page to start with "Overview: the essentials" and then read all you can as soon as possible. Here's the link www.dodgerslist.com/healingindex.htm

Healing prayers for Charlotte.

Yvonne, it is always best to give meds in a treat or give directly in the mouth to ensure the full dose is received.

Pepcid AC is given 2x/day and for a 9 lbs dog that would a 5mg dose. Usual is to give 30 mins before Metacam.  Then give Metacam with a meal as added GI tract protection.

Any pain would mean the pain med Rx is not yet right. Tramadol may need increasing in dose. Adding pain relievers for the these two types of pain: methocarbamol for painful muscle contractions and gabapentin for nerve pain.

The idea with conservative treatment is to limit the number of footsteps to the minimum. Less movement of the back, the less chance of disrupting the scar tissue the body is forming on on the exterior of the disc.

Let us know any changes to the meds list and what the vet says after your appt today.
9 pounds
metacam 4 kg dose 1x/day for 7-14 days
tramadol 20 mg 3x/day
Pepcid AC 5mgs 2x/day

What country are you in as I see your spelling of "centre"?

Yvonne, can you give us some specific observations of the back legs are worse than yesterday.
-- Does she wobble more
-- Does her back left paw knuckle under and she is slow to right it or can't place the paw right?
-- or.......?
-- Did you report the worsening of the back legs to the vet? What did he say?

I would take her out to pee every 4-6 hours... just the same as any dog would want to relieve themselves. Carry her to and from the potty place and being as careful as you are doing in limiting movement of the back. Least amount of footsteps to take care of potty needs.

Do let us know you are not observing any signs of pain after moving nor nearing the next dose of Tramadol.
www.dodgerslist.com/index/SIGNSepisode.jpg

Yvonne, when you can please do fill us in about the back leg(s):
Can you give us some specific observations of the back legs being worse than yesterday.
-- Does she wobble more
-- Does her back left paw knuckle under and she is slow to right it or can't place the paw right?
-- or.......?

When nerve functions are being lost, then a vet may seriously consider taking action to prevent further loss of functions. You will need to be watchful and report to the vet. Hours matter when there are diminishing neuro functions. A switch from the current NSAID (metacam) to steroids needs to be timely...hours again do matter.

As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order.
1. Pain caused by the tearing disc & inflammation in the spinal cord
2. Wobbly walking, legs cross
3. Nails scuffing floor
4. Paws knuckle under
5. Legs do not work at all (paralysis, dog is down)
6. Bladder control is lost.. leaks on your when lifted.
7. Tail wagging with joy is lost
8. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.

EMERGENCY switching to steroids
When there is neuro loss, the lessor of the anti-inflammatories the NSAIDs are not usually continued with.  The most powerful of the anti-inflammatories, the steroid class, is considered.  With emergency of loss of legs, then a vet may deem it worth the risk to dispense with the usual 4-7 day washout in order to save nerves from permanent damage.  THIS IS VERY IMPORTANT: not only would Pecpid AC (famotidine) be on board as it would with any NSAID or steroid but also sucralfate as double protection from the double jeopardy of no 4-7 day washout. Always good to know about meds -- good reading at the Mar Vista Vet page:
www.marvistavet.com/pharmacy-center.pml

You may find this little card handy to have with vet discussions to keep all the meds straight D/l here: www.dodgerslist.com/literature/MedCard.pdf

what the ref card looks like:

I do hope that you get the consult today, Yvonne. You had mentioned that surgery wasn't an option for you. Most surgeons will not operate on a dog that can still wobbly walk and will choose the less invasive treatment of conservative care. The surgeon hopefully will help you get the right meds on board today. Since you're seeing a worsening of neuro function while she's been on the NSAID, most likely the surgeon will choose to switch to the more powerful anti-inflammatory, the steroid. As Paula mentined, usually a 4-7 day washout period is necessary but when a switch is deemed to be medically necessary, the switch can be made with the addition of BOTH Pepcid AC and Sucralfate so be sure to discuss that with the surgeon.

Also discuss the pain meds with the vet. The Tramadol dosage can be increased and Methocarbamol and Gabapentin can be added. It sounds as though Charlotte does not want to come out to pee as she's in pain. That may be why she's not pooping, too, as it hurts her to do so.

Pumpkin can help firm up stools OR it can help to loosen stools. 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. To firm up the stool, add 1 teaspoon pumpkin to kibble and no extra water 1x a day. Note alternatives for constipation: really ripe mashed fresh pear, just take off the peel; microwaved and mashed peeled sweet potato.

We'll be anxiously awaiting word as to how you make out at the referral surgeon.

Charlotte had surgery this afternoon.

She had a ruptured disc. It went well. She is resting comfortably . Will call them tomorrow morning to see how she is doing 

Hi Candace give me your number and I will give you a call Charlotte had surgery today . The operation went well and she is resting comfortably. I will check in again tomorrow morning

Charlotte is home now. The meds are
[9 lbs]
tramodol 15 mg 1 tablet by mouth 8-12 hrs for 7 days 
trazodone 50 mg 1/4 tablet by mouth every 12-24 hrs for 5 days
gabapentin 10mg chews 2 tablets by mouth every 12 hrs for 7 days 
metacam 4 kg dose once per day
i am giving Pepcid 5 mg twice a day 

--------
[Apr 14]:Hi Charlotte will be coming home tomorrow. They called tonight to say she was eating and peeing and resting comfortably. The surgeon had called earlier today that she would be coming home tomorrow that all looked good. I will post again when she gets home

They said to give her the tramodol @ 8 am tomorrow morning( sat)  when they released her..  She had the Pepcid at 8:30.She had the trazodone at 9 tonight ( Friday)and the gabapentin at 10 tonight(Friday). Going to give the tramodol every 8 hrs. I had called the vet earlier because she was not settling down. The vet tech said I could give her a tramodol if I thought she was in pain. She settled down while I was on the phone to the  vet tech and has been asleep now for 20 mins. I will let you know the crate rest and physical therapy in the morning. 

Pepcid AC lasts for 12 hours. So you would want to continue a 7am and 7pm Pepcid AC dose. Give the metacam with a meal as added protection.

Hi Charlotte is off all her meds now. ( since tues her vet visit) She did have a trazadone last night. Should she still get a Pepcid before a trazodone?. I carry her out to pee and poo. Back to the crate she goes. The vet(the surgeon) has me stand her for a few seconds and another thing I have to do is have her walk a few steps. Charlotte wants to be up but we are keeping her in the crate. I had the crate in the kitchen yesterday. Is it ok to carry her in my arms around the house or garden for a change of scene for her. She had a check up last tues and was progressing . She has progressed since there. When I put her down to pee she is walking but I still have her in the sling.she is walking better on her feet now not so much knuckling of the paws she wants to move.... She is squatting to pee the pooping is fine she will be due one when she wakes up. She really wants to get out of the crate and move and I know she has to stay in the crate. How much moving on her feet should be doing

Charlotte will now be 5 weeks post surgery on Tuesday. She had a visit with the surgeon on Friday morning. She is very pleased with her progress. A little more weakness on the right leg then the left leg). Charlotte now gets out for 10 minute walks( up from 5 minute walks) we take her to the park for the 10 min walks. She goes with her buddy zelda( mini long haired dachshund) she also does some exercises( at home during the day) . She can walk backwards( from her obedience days) so we do that she can also walk in a circle both left and righ circles.so we do that. She can also stand a on a small box( made of wood)with her 2 front feet on the box and the rear feet on the floor. We then have her go to the right and left.( while the front paws are still on the box) We put small poles ( from the weave set) on the floor so she can walk over them . They are in a row. I will call the physio person on Monday and see what other things she suggests. I have not tried the water yet I will have to do that at home. The cost here is just too much. While we watch her she is allowed to be in the kitchen. While outside or in the house walking she is always wearing the harness. She still sleeps in her crate during the night and is in the crate during the day when not out for walks or in the kitchen with us . Her next visit is in a months time. She is not on meds anymore. Charlotte is not up yet and it is 8:30am here.

Hi, I was trying to get the video of Jolene's water therapy to play no luck.   I wanted to see what kind of exercises they were doing. I had Charlotte in the tub doing some walking. She was not doing it for long as I don't want to do too much. Is accupuncture a good thing? Do the dogs with ivdd benefit from it.? We are not doing any more of the 2 feet up on the box. I just do small circles now. I stand in one spot and circle left and then circle to the right

Yvonne, here is Jolene's water therapy video clip in a $10 child's wading pool. The water level is what provides increase or decreasing workout. HIgh water level about chest height is easier to walk in. Lowering over days to knee or ankle gives more workout to the limbs.  The article with details on water therapy:http://www.dodgerslist.com/literature/watertherapy.htm  

Yvonne, good news about Charlotte! Practicing swimming is not the same as practicing walking. The lower the water in the tub the more challenge the leg work out is.

I don't have any personal experience/ knowledge of a balancing disc. The best thing is keep the back horizontal to the ground to avoid "standing up vertically" pressure to the discs when doing exercises for an IVDD dog.

What is Charlottes back leg movement look like now... pretty normal, any knuckling... etc.?