Nancy's Romeo May 2016 Conservative—Beagle

Welcome to Dodgerslist. First thing to know is that it IS in the cards for your Romeo to get back to enjoying life whether immediately walking during the short 8 weeks of conservative treatment it will take a disc to heal or waiting on more nerve repair - IVDD is not a death sentence. Find out why that is true: www.dodgerslist.com/index/SDUNCANquality.htm

In order to help you more, could you please answer these questions?

☐ What is your name, too?

☐ Did you specifically get a diagnosis of IVDD, aka: a disc problem, a disc herniation, a bulging disc, slipped disc? Is the vet a general DVM or a specialist (ACVIM neurology or ACVS ortho)?

☐  Glad you started Romeo on 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.

www.dodgerslist.com/literature/slingwalk.jpg

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!

☐  You have a pain emergency!- 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.
We usually see Tramadol given 3 times per day as it is a short acting drug and it works better that way.  Most dogs with IVDD get a combo of pain medications. Adding in Gabapentin 3 x per day, would be a good idea since it works synergistically with Tramadol. Discuss  adjusting the pain medications with your Vet right away.   Let him know Romeo is in a great deal of pain, not even able to lie down and crying. The correct amount to administer can depend on several factors including your dog’s breed and medical history.  Pain slows down healing and once it is under control it will be a lot easier to care for Romeo. 

As far as peeing and pooping once pain is in control he will hopefully be able to do both.. If he can't he would have to be expressed.. If that happens get a hands on your hands lesson from the Vet or Vet tech on expressing. More info and videos here:  dodgerslist.com/literature/Expressing.htm

"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

Please include the all important stomach protector such as Pepcid AC.  Not Prilosec!  Pepcid works faster and has less side effects. Phrase the question to your vet this particular way:" Is there a medical or 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.

☐ Currently can your dog wobbly walk? Move the legs at all? Or wag the tail when you specifically do some happy talk?

☐ Can your dog specifically sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up?

☐ Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood?  

Excluding an emergency of pain not being controlled or diminishment of nerve functions that require prompt vet help, we have excellent resources for many IVDD questions members have. While you are waiting for a reply, do check out our "All things IVDD" resources for getting the recovery suite setup to an overview of just how Conservative Treatment works: www.dodgerslist.com/literature.htm

----- Why Chiropractic is not recommended for IVDD dogs: www.dodgerslist.com/literature/chiropractic.htm

The unknown is simply too scary a place to stay in. Are your 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. Are you ready? Here's the link www.dodgerslist.com/healingindex.htm

Glad you are here with us, Romeo is lucky to have you.. All of us here have dogs with IVDD so you came to the right place! 

Hello again,  we did get the Gabapentin.  Also, I read the vet record and the xray did show disc narrowing (my husband took him to the vet and did not know about IVDD at the time).  

[28 lbs
Prednisone as of 5/20: 10mg 1x/day for 3 days, then taper 5/23
Valium  5mg 2x/day
Tramadol  50mg 2x/day
Gabapentin  ?mgs  ?x/day]

Romeo's pain is under control but ▼prednisone weaning is to start tomorrow [5/23].  We will have to request the Methocarbamol as suggested.  They said they rxd the Valium is for muscle relaxation.  

Are we to expect more pain when the prednisone is weaned?  They didnt give us many pills (only about 1 weeks worth). Cant vets prescribe 30, 60, 90 quantities with refills like Physicians do?  

Thanks again...

Nancy, it is very confusing with another pain masking pain med (gabapentin) just added AND a test for pain pred taper to being today 5/23. How can there be a true test for pain when pain meds are on board  or not being backed off at the time of the taper?

Let us know the exact details of gabapentin (?mgs ?x/day)

If there is existing pain then certainly this would not be the time to begin a pred taper.

A three day course (taper days do not work on swelling) of pred is VERY short. So if there is to be taper starting today, then all three pain meds would either be backed off  OR stopped with the begin of the pred taper. Which way does your vet prefer?
      Honestly in my mind with the just now prescribing of Gabapentin by the vet, it is likely not time time to taper because Romeo IS still in pain.

Often a course of pred will be for 7 or 14 days and then a taper tried.

During a taper the job of the owner is to observe for pain being revealed and report it. Pain is due to swelling and the pressure in the spinal cord. Getting swelling down as soon as possible is to ward off damage to nerves.  Nerves cells die when there is pressure to the cord. When one nerve cell dies there is a cascading death effect for adjacent cells as chemicals are released. Increasing nerve death is observed by us and needs to be reported to the vet to get pred back up at the original anti-inflammatory dose:
1. Wobbly walking, legs cross
2. Nails scuffing floor
3. Paws knuckle under
4. Legs do not work (paralysis, dog is down)
5. Bladder control is lost
6. Tail wagging with joy is lost
7. Deep pain sensation (DPS), the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. Surgery can still be successful in the window of 12-24 hours after loss of DPS. Even after that window of time, there can still be a good outcome.

What is the stumbling block to getting Pepcid AC (famotdine) on board (10mgs  2x/day)?

A vet could prescribe 30 days worth of tabs.  It may be smaller qty from what he has in-house gives the vet better control that pills are not misused or he is insured to get feedback from owners .  When meds are purchased at human pharmacy the cost is less with 30 tabs per Rx. You might discuss the reasoning behind his Rx. 

Hi Nancy,

Yes it is fine to give Gabapentin at the same time as Tramadol.  They actually work better together.  A kong is okay to give him as long as he doesn't get too rambunctious. 

Was there a change in food to cause the diarrhea?  You mentioned "something new".  It can also be caused by Prednisone.. While Pepcid works great on the acids Prednisone can cause, a few dogs also need Sucralfate. 
Contact your Vet to let him or her know about the Diarrhea if it wasn't from a new food but adverse side effect of Prednisone. Ask for a prescription of Sucralfate. 

Sucralfate not only “bandages” the ulcer but accumulates healing tissue factors in its bandage; it not only protects the ulcer but actively assists in the healing procss. In order to be most effective, this med should be given:
1.  30 minutes prior to Pepcid AC

2.  Give on an empty stomach at least one hour before feeding.

Read to know which meds do NOT work well with sucralfate and other options for dose order and timing:  www.marvistavet.com/html/sucralfate.html

Nancy, diarrhea is a red flag sign of GI distress, most likely caused by the Prednisone. Most times Pepcid AC is enough to protect the dog from these side effects but should signs such as diarrhea start, Sucralfate also needs to be added to double protect as Pauliana recommended. It's most important to speak to the vet about adding Sucralfate this morning as GI distress can worsen quickly and can become a very serious problem.

You can put an ex-pen outside to make a small potty area or make a 6' potty area using plastic push-in-the-ground fencing. Only allow a few steps to do his business and then carry back to the crate.

Please let us know what the vet says after speaking to them this morning about the diarrhea.

What did the vet say about the diarrhea? We are concerned because that is often a sign of GI problems caused by pred that can become very serious.

It is quite common for dogs to need more than one taper of pred. Several are sometimes needed. How it usually works is the pred is tapered and the pain meds are stopped. If there is no pain at this point it means that no swelling is present and only the 8 weeks of crate rest remain. If pain returns the swelling is not gone and more time on the full dose of pred, the pain meds and the Pepcid are needed.

It is a very good sign that he is not wobbly or incontinent. He is a good candidate to be healed by the conservative treatment.

Hi Nancy,

The taper of Prednisone is also a test for pain. If Romeo has no pain that means the swelling is gone and the taper can continue until completion.  If Romeo does show signs of pain during the taper that would mean he should go back to the twice a day dose of Prednisone immediately for another course.   If he shows no pain, there would be no reason to go on a NSAID.    

Pain medications are usually stopped during the taper so you can quickly see if there is pain or not. If pain meds are given it muddies the waters so you can't tell if swelling is gone or not.  If Romeo has to go back on the Pred, the pain meds should be back on board as well, along with the Pepcid. 

Nancy when a disc episode happens there is usually a building up of pain as the disc worsens and pushes into the spinal cord. Too much pressure and the cord dies where we observe neuro deficits. So with a dog known to have been born with disc disease, any time there is a hint of pain, we naturally think it a disc episode. Crating at once is to prevent further disc and cord damage. Getting to the vet to get the right diagnosis asap is important.

There are other diseases which can mimic a disc episode. Arthritis can cause pain...it usually upon exercise will ease up and not be so stiff to move about. The important point is getting to the vet for the right diagnosis. You might like to get a a good general idea of the disease you are dealing with .... a 10 minute on-line course in IVDD: www.dodgerslist.com/literature/IVDDcourse/

Most dogs need some 16-18 hours of sleep per day, people sleep 8-9 hours day. What are they doing in the recovery suite? Laying around and sleeping! Don't give into the temptation to start a treat routine to combat non-existent boredom.
What you CAN try is to have Romeo work for his dinners. Soak his kibble in broth and freeze each of his normal kibble portion into a Kong so he has a job... working for his two daily meals.

His recovery suite could be rolled near the sliding glass door so he can see what's going on outdoors. If a nice day, roll the suite on to the deck for some fresh air and to keep you company when sitting on the deck.

Nancy, thanks for sharing! It does give hope & inspiration to those just getting an overwhelming IVDD diagnosis. We would just LOVE to have a current photo of Romeo and a couple of sentences for the 2016 photo gallery. Your continued updates are wonderful to see how Romeo is doing over the years. Thank you for taking the extra effort to share!

LOGIN www.dodgerslist.com/gallery/ :

username: Dachsie

password: dodgerslist14

Or you can email (owner's name, email addy, dog's name + photo caption) to : photogallery@dodgerslist.com


Happy Crate rest graduation to Romeo!  

Thank you so much, Nancy! Your donation is much appreciated!  Romeo is such a handsome fella! Thanks for adding his picture to the gallery! 

Hello everyone,

Romeo has been well since his 2016 episode. Through forays around the farm he has slowly built up muscle strength to support his back but is a mellow guy so nothing really strenuous goes on. He seems to know his limitations and adjusts himself accordingly. Keep up the great work! 💙