Jared's Jill 9/10 relapse conservative —Chiweenie GRAD:11/8

Jared, welcome to Dodgerslist. I'm so glad to hear you did not take that ill informed advice to kill your dog because has a disc problem. Knowledge IS the power to care for Jill and the knowledge how to live with an IVDD dog for many happy years ahead.

FIRST PRIORITY
Today asap after 100% crate rest,
--- pain in control.   Not moving much, reluctant to move is a sign of pain.  If you believe she is in pain she needs help, needs her pain meds adjusted (Tramdol, methocarbamol, and Gabapentin). There is no reason when all it takes it adjusting/adding in to have a 3-way combo. IVDD pain meds:  www.dodgerslist.com/literature/healingpain.htm
All about steroids with IVDD: www.dodgerslist.com/literature/healingsweling.htm
--- is to get a hands-on- top-of-your-hands lesson in expressing the bladder due to health reasons.  Leaking when pick up or finding leaks in bedding likely means loss of bladder control.  Being able to sniff an old pee spot outdoors and then choosing to release urine there is proof of bladder control.  Let us know.  If you need a vet lesson today, first review the video and the tips to get more out of the lesson:  www.dodgerslist.com/literature/Expressing.htm
--- Stomach protection-- Pepcid AC (famotidine) to suppress the extra acids steroids cause.

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Was 100% STRICT crate rest 24/7 only out to potty for a full 8 weeks Rx'd on Tues, 9/6?
What is the exact list of meds, with mgs, and frequency given

25 lbs
steroid name?  Date steroid started?  Initial dose in mgs?  ?x/day;  Current ?mgs, /?x/day
Tramadol  mgs and frequency  
Stomach protector  ?mgs  ?x/day

STOMACH PROTECTION
Prednisone, Prednisolone, Dexamethasone, etc are involved with stimulating gastric acid secretion causing GI upset of not eating, vomit, red or black bloody diarrhea which can quickly lead to bleeding ulcers or life threatening holes in the stomach or intestine. Phrase the question to your vet in this particular way: "Is there any medical reason my dog may not take Pepcid AC?" If there is no reason, we follow vets who are proactive in protecting the stomach by giving doxies 5mg Pepcid AC 2x/day. Give steroid with a meal for extra protection. Knowledge about each med your dog takes is the added layer of protection. Good link to bookmark and read about Pepcid AC:
www.marvistavet.com/pharmacy-center.pml

The usual dose during a disc episode is Pepcid AC (famotidine) for dogs is 0.44mg per pound 30 mins before the anti-inflammatory and thereafter every 12 hours. Give the anti-inflammatory with a meal as added protection. www.1800petmeds.com/Famotidine-prod11171.html

CRATE REST
The crate is the only surface that is firm, supportive for the spine, not inclining, always horizontal and keeps a dog from darting off at a TV doorbell (even paralized dogs can dart!) and safe from other pets and kids from bothering them. The rest of the details of doing crate rest to ensure the best recovery in this excellent document:
www.dodgerslist.com/literature/CrateRRP.htm

The purpose of crate rest is to act as a cast of sorts to let the disc heal… only limited movement of STRICT crate rest allows that to happen…there are no meds to heal a disc. Immediate neuro improvement may or may not come during the 8 weeks of crate rest… as nerves may take more than 8 weeks to heal.

DIET
During crate rest is not the time to be on a diet The reason is nutrition is never more important than during healing. The body actually needs additional protein and nutrients because the body is calling upon its reserves to fuel all the many repair jobs that have to be performed so that healing can take place. Now is no time to be restricting and denying the body that badly needed nutrition by reducing portions just because because of inactivity. Discuss with your vet the idea of adding some additional protein to his kibble to assist the body with healing. Maybe one sardine canned in spring water with no salt added 1x/day..there are several little sardines to a tin. Vitamins and minerals are best absorbed by the body through foods in their natural form A sardine comes with nature’s packaging in the right proportions of calcium via bones, protein from meat, and Omega 3 fatty acids (anti-inflammatory action) in the skin.

Hang in there, never give up, keep reading!  Please keep us updated on the expressing lesson, getting pain fully controlled and stomach protection.

Jared, don't give up on Jill. Surgery isn't the only answer. Crate rest can often do wonders. I couldn't afford surgery the 2nd time my dog went down and she made a full recovery. Healing wishes.

Wagging the tail with joy is an excellent sign of nerve healing.

Is Jill currently showing any signs of pain? I hope when you say you are not giving meds because you are not confident in the vet you are not including the pain meds if she is showing any signs of pain. 50 mg of tramadol is a dose we commonly see prescribed for a 25 pound dog. Tramadol has a short half life and is most effective when given 3X a day.

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 dosages from 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 veterinarycalendar.dvm360.com/new-developments-opioids-old-drugs-and-some-future-directions-proceedings

Have you started the Pepcid yet?

How is the expressing going? Expressing is a skill and has to be practiced to be learned. I struggled with learning to express my Frankie. I had to go back to the vet for several hands on lessons before I was able to do it. Once you learn it, taking care of Jill will be so much easier.

Quite a few of our members have used acupuncture or laser therapy to help relieve pain and to also to kick start energy production in nerve cells to sprout. When considering acupuncture or laser always consider if the therapy makes up for having to transport your dog. If you need to transport Jill pad out the crate's extra space with rolled up blanket so her body will not shift during breaking or cornering.  We have some information about acupuncture and laser here: www.dodgerslist.com/literature/healingacupuncture.htm

Good news that Jill is not in pain.

When she pees on her own is she producing a good stream and do you feel she is really emptying her bladder?

Dogs on pred want to drink more and then they need to pee more. They may have to be taken out as often as every two to three hours. It may be that Jill has bladder control but because she took the pred yesterday she just needs to go out more frequently.

Jared you have a decision to make along with the new vet about a switch from a non-steroid anti-inflammatory drug (NSAID) like Meloxidyl® (meloxicam) to the other class of anti-inflammatory drugs, the steroids like prednisone. 

Answers: www.dodgerslist.com/literature/healingswelingANSWERS.htm

25 lbs
Meloxidyl as of 9/6:  1.5/10ml 25lb dog dose 1x/day for 11 days 
Tramadol 50mg 1x per day.
Prednisone Rx'd as of 9/12 but not ever given: 5mg  2x/day.

When there has been a loss of neuro function to being paralyzed, hours matter in the switch without a 4-7 days washout to the strongest of the anti-inflammatory drugs in an effort to stop the death of nerve cells. It will have been 5 days now, 120 hours later, since having lost use of legs. It may be too late to risk doing a switch without the normal 4-7 days washout from NSAID to a steroid. When it is deemed an emergency to switch and dispense with the washout, then a vet knows that two stomach protectors must be on board (Pepcid AC and sucralfate). The vet prescribing the pred without a washout did not appreciate the real danger of death he put Jill in. He never even had her on Pepcid AC with the NSAID.

It is very likely now it is too late to prevent further nerve damage with a quick switch to a steroid. It is time now to see how much the body can self repair that nerve damage.  Anti-inflammatories do not help the body repair nerves.  Having been on the NSAID now for 11 days AND you have stopped all meds as of 9/13, you are in effect doing the test for pain.
-- If you see no signs of pain, then that tells you all the swelling in the spinal cord is gone..no need of any meds at all.  
-- If you would see any hint of pain surfacing that would indicate the need to get back on the pain med pronto to give comfort and discuss with the new vet the approach with either a continued use of Meloxydil (NSAID) or use prednisone (steroid) with a washout or the more risky no washout but 2 stomach protectors (Pepcid AC and sucralfate)


We'll await hearing back hopefully that no pain surfaces and no meds at all are needed.  IF there is pain, do let us know the new med list (mgs and frequency)  and this time Pepcid AC is on board right away. 

The peeing on you when lifted is worrisome as it shows lack of ability to hold in urine til in an appropriate spot.  Jill may have developed a urinary tract infection (UTI).  Discuss with the vet his thoughts and if a urinalysis is warranted to see if there are bacteria and the need of an anti-biotic.

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I can't believe they would even say that, without even discussing options! Best wishes to you and Jill, a speedy and lasting recovery. 

Good news about the new vet. It is so important to have confidence in your vet. You are absolutely right that Jill will pull through this.

How is she doing with the peeing? Is she staying dry?

Jared, good news there is not paralyzed legs. What did the vet say about the urine leaks... any thought to a urinalysis?

She may have some degree of bladder control. So I would continue to bring her outdoors to sniff an old pee spot when you know she should have to go.  Make sure the sling is not touching the tummy area for an accurate "sniff and pee" test. Support her thighs with your hands if need be. If she releases urine on the spot, do a quick express check to verify she is totally voiding the bladder.

Expressing when a dog does not have full control of the bladder is for two health reasons.
-- The bladder can release urine when overstretched to the point reflexes kick in and release urine. Things like a towel sling and picking them up is kinda like expressing (puts pressure on the bladder causes reflexes to open the bladder neck). Bladder control is the ability to override reflexes and wait til in an appropriate spot. The reflexes do not release all the urine, so the remaining urine quickly become a breeding ground for bacteria (urinary tract infection). That is why my thought was to bring up urinalysis to the vet when telling about the urine leaks... see if an infection is the possible cause of leaking.
-- Constant over stretching of the bladder will cause it to loose tone. When the brain can properly message the bladder, the bladder won't function right.
-- Review this video before getting a hands on lesson to get more out of the lesson: www.dodgerslist.com/literature/Expressing.htm
-- Does Jill poop in her recovery suite, indicating there is loss of bowel control? how to express for poop: www.dodgerslist.com/literature/Expressing.htm#poop

PREDNISONE
-- Did pain surface indicating there is still more work for an anti-inflammatory drug to do?
-- If Jill has no pain and is still not taking any pain meds, then what explanation did the vet give for going back on an anti-inflammatory drug?
=== anti-inflammatory drugs do not heal a disc, don't heal nerves and don't prevent another disc problem.

The Medication LIST tells us alot about the situation. Could you copy/paste and adjust in your next post the below LIST

[25 lbs]
Meloxidyl as of 9/6: 1.5/10ml 25lb dog dose 1x/day for 7 days (STOPPED 9/13)
Tramadol 50mg 1x per day. STOPPED
Prednisone Rx'd for 9/16: 5mg  2x/day? for 7 days, then taper
Pepcid AC  10mgs  1x/day

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.

Can Jill move her back legs at all excluding potty times? May use them to reposition herself in the suite?  When she stands do the paws knuckle under or can she place them correctly on the ground?

Hi Jared,

Urine that is dark and stinky is also symptom of a UTI.  Jill should have a urinalysis done and if she has one they can put her on an antibiotic.   UTI's can move up into the kidneys and become life threatening, so it is better to have her tested to be on the safe side.  UTI's are very common with IVDD dogs.  

Encourage her to drink by making low salt home chicken broth or hamburger broth..Canned broths from the store contain onion powder which is toxic to dogs. 

Pepcid AC lasts for 12 hours, so once a day is only protecting her on her first dose of Prednisone.. It is better to cut it in half and give 5mg 2x/day 30 minutes prior to the Pred and always give Pred with a meal for added protection. 


Healing thoughts and prayers! 

You shouldn't need a vet visit but need only take in a urine sample to have it tested. They test it in the office, usually while you wait. If there is a UTI, an antibiotic would be prescribed. Neither the urinalysis or the antibiotic should be very expensive. You would still need to pay for the urinalysis and possibly a prescription next week. I'm sure the vet would let you know the cost of this if you call them. As Pauliana said, this shouldn't wait and Jill's urine should be tested soon to rule out a UTI. If you can get a urine sample to take into the vet, it would be better than actually taking Jill for yet another visit since the less movement of the spine, the better, and transporting to the vet is risky.

Good that Jill does not have a UTI.  Pred does make dogs want to drink more and therefore pee more.  You will need to take her out more often.

If she still doesn't want to drink much Pauliana's suggestion of making broth might help.  You can also soak her kibble in water which will add more water to her diet. 

That's terrific!! Yay Jill.

She is still peeing great on her own, but, we are a little concerned, despite eating normal, no poops for 2 days.

Lots of pain meds are constipating. Try the pumpkin or other fruit advised and really encourage fluids.