Ashley's Lulu 5/2016 Conservative- NYC

Ashey, I'm so sorry to hear Lulu is having another disc episode.  Getting up to speed on IVDD, you come to an understanding this is a progressive disease and unpredictable.  Some dogs have only one disc episode their entire life while others can have multiples. Any one of the 26 discs could at some point bulge, tear as it looses flexibilty.

Vertebrae illustration
The neck C1-7, Chest T1-13, the low back L1-7

I just want to let you know that crate rest with conservative treatment is necessarily more strict that for post-op crate rest.  

Conservative medical treatment does often work when owners are are committed to the treatment. Sometimes everything is going along pretty nicely, the dog is less and less painful, getting around better etc, and it seems like what harm to let the dog out of the recovery suite, sit on your lap, walk around at potty time. The harm is too much movement! The early healing disc bursts open the rest of the way and the poor dog may be paralyzed for life.  
      It won't take much to bone up and get up to speed on your dog's disease. Follow the button that pertains to the situation now at hand. As time permits in the next days, do check out all the colored buttons on this page for many happy years ahead of living with an IVDD dog. Today you will want to click the YELLOW button "Conservative Treatment: Overveiw essentials" at this link: www.dodgerslist.com/healingindex.htm
Got family/friends, who in the future may be sitting your Lulu? The "Disc Disease" DVD is a wonderful way to help others understand. Priced at $3 so everyone can afford: www.dodgerslist.com/store/DVDorder.htm

Do 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.
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! 

As you may recall we are a group who LOVE the details.  Do fill out the med list for us.

Lulu's current weight still 11 lbs?
tramdol  ?mgs  ?x/day
rimadyl ?mgs ?x/day
gabapentin ?mgs ?x/day
Pepcid AC ??

Did you start strict rest on 5/28 on the same day as the Vet appt?

Was the vet a neuro (ACVIM) or an ortho specialist or your local general vet?
Is all pain fully in control dose to dose of the two pain meds, Tramadol and Gabapentin.

Do you now have Pepcid AC on board?

Ashley, let us know your country.

Did the vet think her neuro functions had diminished?  Let us know the details of her leg function.

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
5. Legs do not work (paralysis, dog is down)
6. Bladder control is lost
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. 

Never give up hope, conservative treatment can work. There are no guarantees with surgery as there are no quarantees with conservative treatment. Not every family can handle the expense of multiple surgeries.  My Clark had  2 surgeries and something went wrong. He's, nevertheless a very happy handicapable guy sending you and Lulu best of wishes for a good recovery.

Pain meds are not correct if you are seeing pain still. "seems a little bit better is not good enough. Have no patience with pain. When meds are correct pain would be in control in one hour and stay that way dose to dose.

Be sure to give Tramadol and Gabpentin promptly every 8 hours. They have a short half life and likely would not control pain if given less frequently.  The best pain control during a disc episode, as in people, comes with multimodal pain management: using more than one approach that addresses pain from multiple fronts.

Muscle spasm pain is pretty typical. There is no med on board to address this kind of pain.  Methocarbamol is the med. Again do your reading to so you know why you are adovcating for full pain control.  Do you have the Mar Vists Vet page bookmarked yet?  LOL:   www.marvistavet.com/pharmacy-center.pml

11.2 lbs 
Tramadol: 50mg: 12.5mgs 3x/day
Rimadyl: 25 mg tab:  12.5 mgs 2x/day
Gabapentin: 50mg/ml giving 1ml every 8 hours

Any dog who can do a happy tail wag, has bladder control would naturally still have the last neuro function to dissapear (DPS) General vets often get DPS wrong. So only rely on a board certified specialist to correctly identify DPS.

If surgery is not an option, then it you need not transport and get a DPS identification.

This information is to keep in the back of your mind. Discuss with your vet so you both are on the same page if neuro function would diminish with a "Plan B"

When there is neuro loss, the lessor of the anti-inflammatories the NSAID like Rimadyl 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.

You will want to understand why you are advocating for sucralfate along with Pepcid AC and have a plan to time it properly with food and other meds including with Pepcid AC. 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:


All about how anti-inflammatory drugs work with a disc episode: 
www.dodgerslist.com/literature/healingsweling.htm

Has anyone else's dog experienced another episode after surgery within the same year?

My dog is 8 months post-op and is now having another episode. I am trying to decide if surgery or conservative treatment would be a better option. It seems so much to have more surgery only 8 months later for her body?

She is not showing signs of pain. I was just not sure if those things would help healing.

I asked her vet about pepcid and they said they do not recommend [Pepcid AC] giving it to her right now and I should only if she begins a steroid.

I am hoping conservative treatment does not harm her and her condition does not get worse and then results with surgery being the option. 

Her left paw is very weak and she barely brings it back into position when I try to roll it under (not sure if I am describing that right). I called the hospital - am waiting to hear back from the neurologist to see if he suggests I bring her in to see him for testing. 

Thank you!!

How often during an episode do you think they should be urinating? I feel like she may be holding it and not going as often as she normally would because she may be uncomfortable to get into the right position. 

any tips to relieve some tense muscles? it seems since my dog is relying mainly on her front paws her muscles and neck feel very tense. besides massage is it safe to use a warm / cold compress on this part of her body?

the Rimadyl is done and the tramadol.

[11.2 lbs
Rimadyl 25 mg tab as of 5/29: 12.5 mgs 2x/day STOPPED on date?
Tramadol: 50mg: 12.5mgs 3x/day  STOPPED
Gabapentin: 50mg/mlL:   1ml 3x/day]

I called the neurologist yesterday - 2x still haven't called me back.

now she is on Gabapentin: 50mg/ml giving 1ml every 8 hours. but it was suggested to me by her physical therapist last week who is also her vet to access it and maybe only give every 12 hours!

I am seeing him again Thursday for another acupuncture and laser session. her disc problem was assessed to be in her back on the left side. she doesn't to me look as though or act like she's in any pain but her neck muscles do feel tense when I massage her.

Ashley, why is she still on gabapentin. You have no conclusive evidence that all the spinal cord swelling had been taken care of by Rimadyl until all pain masking pain meds have been stopped.

I think all of us have come to the realization that not all caring and well meaning folks know IVDD. Otherwise why would they recommend putting an early healing disc in jeopardy by unnecessary movement? This is one disease where owners need to be firm in their understanding of the purpose of 100% STRICT crate rest for 8. This is so we can protect our dogs and politely say no thanks to harmful advice or treatments.

Perhaps you will be able to educate the PT person so she does not advise harm to the next conservative IVDD patient.
www.dodgerslist.com/literature/healingdisc.htm

Hi Ashley,

Dogs are on pain meds and anti inflammatories only until the swelling is gone. That timing varies from dog to dog.. When the Vet guesses the swelling might be gone they call for a stop of the Rimadyl. At the same time the pain meds are stopped.  If the swelling is really gone, there would be no signs of pain.  If the swelling is NOT gone, pain signs would show up right away and then you would know that there was more work for the Rimadyl to do and the need to go back on all meds for a bit longer.  Pain=swelling=more time on all meds! 

Hi! What are some recommendations on dog toys after recovery? LuLu is a dog toy destroyer and I do not want to give her anything to stress her neck!