Mary's Oscar 11/4 Surgery 4-6wks

Mary so sorry to hear Oscar having a disc episode.

Is this time just pain and no neuro dimishment...no wobbly walking, no knuckling paws?

How much does Oscar weigh?

Is his pain fully control with the current meds? that is you see no: 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, can’t find a comfortable position, Arched back, pinned back ears. Holding leg flamingo style not wanting to bear weight, head held high or nose to the ground. Not their normal perky interested in life selves. Never have any patience at all with pain. When meds are correctly dosed for your dog’s body, pain is covered dose to dose and when having to move such as at potty time.

Please call the vet to verify that Oscar has no health issue to keep him from the safe for a healthy dog Pepcid AC (famotidine) Pepcid AC suppresses the extra stomach acids that prednisone causes. So we follow the vets who are proactive in preventing nausea, vomit, diarrhea, blood stool, bleeding ulcers from progressing to life threatening perforated stomach lining. The usual dose of Pepcid AC (famotidine) with a disc episode is 0.44mg mg per pound every 12 hours and giving the anti-inflammatory with a meal for added protection. Get Pepcid AC at the grocery store but FIRST do ask your vet in this particular way: Is there any health reason (heart, liver, or kidney) my dog may not take Pepcid AC (famotidine)? Know all about your pet's meds, reading IS important: www.1800petmeds.com/Famotidine-prod11171.html and marvistavet.com/famotidine.pml

During conservative treatment, anytime out of the recovery suite is a dangerous time for the healing disc. Movement of the back can increase a disc tear and escape of disc material into the spinal cord . For an animal with very mild neuro deficits, the risk of transporting has to be weighed with the benefit of having the vet see Oscar.

What benefit outweighs the risk of transport to the neuro surgeon when surgery is not an option?

Oscar got a rather short 4 day course of prednisone. Often vets will make that guess if painful spinal cord swelling is gone with a 7 to 14 day pred course. So do not loose any hope if there is pain on the test-for-pain prednisone taper. It often will take several courses before all the swelling is resolved. Since nobody knows how many courses it is always prudent to try one course and see if it is possible to go to final taper without pain.

Rule of thumb is: pain = swelling = more time on anti-inflammatory, pain meds and Pepcid AC needed.

Let us know if there is a stumbling block to getting the acid suppressor Pepcid AC on board for Oscar.

Mary, good job in getting feedback to your vet via a phone call to get meds adjusted. Sounds like your primary vet is on board with getting the swelling down and knows that it may take a couple of courses of pred to do it.

For how many days did he want the 2.5 mgs 2x/day?
Did he OK the usual dose of Pepcid AC for 5mgs 2x/day?

Hi Mary!

Sorry to hear that Oscar was having symptoms of pain after his pain medications.. Did his pain resolve within the hour after giving the meds??  If not his pain meds are not yet right and need adjusting.   Call and let the Vet know what Oscar is experiencing.  He needs to be pain free from dose to dose..  They can add Gabapentin, it is very effective along with Tramadol.  Works very well for my Tyler during his disc episodes.. 

Mary, with the anti-inflammatory dose there is a range. Different diseases may do well at the lower end. Normally we see vets using the higher end of the anti-inflammatory dose range for a disc episode with Prednisone. You might discuss if moving to the upper range would help to expedite getting spinal cord swelling resolved as you also speak about using a more aggressive approach with pain meds for full dose to dose coverage.  

CAVEAT: It is important to do your own reading about meds so you can participate in discussions. The reason for you to not self prescribe is your vet has responsibility for the health of your dog in meds he prescribes based on his exam, the health history of your dog, how meds interact, not things we or you might know as we are not veterinarians. Vets should be open to treatment options because vet medicine is not a black and white science.
Since Pred comes in 5mg tabs often a vet will round to the nearest size tab/or split.... such as 5mgs Pred 2x/day rather than a hard to split to a 3.6mgs 2x/day dose.

Let us know what your vet's thinking is and what changes to the med list he makes.

Well its been a few days since we at the Gabapentin to Oscars plan. He seems to be do very well with this addition. He is resting much better, and does not seem to be in pain and seem to be more alert when out of the crate for potty time. He does seem depressed up I sure that is normal form the meds and crate time. Lots of love talk and treats. He is drinking quit a bit of water, but i know that is from the meds. Gait is good wags tale and seems to be walking with ease.
We start the to taper the Pred this weekend, just hoping the pain does not return....
I was wondering how long he will have to take all the pain meds for? Going to put a call into dr? Earlly in the week to ask? I'm going away this weekend and my husband will be taking care of Oscar at home, keeping my fingers crossed that he continues on the path to recovery.....

Vet spoke about tapering the pain meds, but did not give clear understanding of which ones and when .  I am really nervous of doing this over weekend, but I have plenty of Pred and Pain Meds. to get me through the weekend. Refilled at Neruo. How bad would it be if we waited to start tapering until Sunday evening instead of Saturday? I'm only going to be gone Saturday morning and returning Sunday evening. My husband can log on here if he needs. 
What if the pain returns when taper, does this mean pain will never go away? Nuero said they don't even think of 2nd surgery as a last resort. 
 

The way the taper usually works is that the pred dose is cut down and all the pain meds are  tapered or stopped.  If pain returns  there is still swelling in the spinal cord and the full dose of pred and the pain meds and the pepcid are started up again.  Then after another 5 to 7 days the taper is tried again.  It is quite common for more than one taper to be tried before all the swelling and therefore the pain is gone, so there is no need to worry about that. 

I don't think there would be a problem in starting the taper a day later if you would feel more comfortable doing that, although best to check with your vet. But since you have extra pain meds on hand, if any pain is seen, you will be able to start everything up again right away. 

She had a 3 year "vacation" from IVDD but right now she's on crate rest for an episode. I'm going to try cold laser therapy for her next week. Surgery can definitely help but as you and I have found out it's not a cure. However, crate rest will often work wonders. Have a good trip. We pet parents have to care for ourselves too. Hugs to Oscar!

Mary, MRIs as well as xrays, require anesthesia. A dog's main defense against further disc damage is dependent upon control over the core trunk muscles – this defense is eliminated with anesthesia.

So pictures are used for a specific purpose. Often it is the dog's history, the breed and how the dog presents at the visit which allows most disc episode diaganosis to be made. When a vet is suspicious that there may be another reason for back pain, such as a fall/car accident where the vertebrae may be cracked, tumor, etc, then an xray would be worth the risk to give a better diagnosis and the right treatment. MRI's can prove a disc episode, but mainly are used to plan out the surgical procedure. With conservative treatment it does not matter which disc as all discs receive the same care of limited back/neck movement so the disc can heal.

Crate rest is to allow the disc to heal in 8 weeks. IF there have been several attempts to go off the meds and yet pain still surfaces, there is something going on with the spinal cord...something is pressing on it.
---This is where a vet might then want an MRI to see better what is going on.
---The hope with conservative treatment is that meds help to get the spinal cord swelling down AND the disc where it is not supposed to be will be reabsorbed or shrink back enough that the spinal cord will no longer be aggravated.
--- When for whatever reason surgery would not be an option, and pain would not get resolved, it may be the vet would use meds long term at the lowest dose possible so the dog can enjoy life through the miracle of modern medicine. Same as some people stay on meds to keep pain at bay with some diseases.

Once 8 weeks has passed, then the disc has healed. We've got our fingers crossed for pain to be resolved on this pred taper.

Often two or more signs of pain helps to best confirm if there is 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, can’t find a comfortable position, Arched back, pinned back ears. Holding leg flamingo style not wanting to bear weight, head held high or nose to the ground. Not their normal perky interested in life selves.  

Hi, Mary. I definitely would speak to the neuro about stopping or tapering the pain meds at this time so a true test for pain can be made. Pain means there's still swelling pressing on the nerves of the spine and therefore there would still be the need for the anti-inflammatory dosage of the Prednisone. Anything less than the anti-inflammatory level of the Prednisone would not be effective in getting the swelling down. The pain meds could be masking the pain so it would be difficult for you to tell whether there is still pain/swelling.

It can take 7-30 days for that swelling to resolve. So it's not uncommon for the first or even second taper of the anti-inflammatory to show that there's still pain/swelling. Being hesitant to move, not himself, timid could be signs of pain. He should be his usual perky self. So do speak to the neuro about tapering off or stopping the pain meds so a good test for pain can be made. If pain returns, then all meds need to be returned to the original dosage and conservative care continues.

Usually vets don't have to physically examine a dog during conservative care unless there is a worsening of condition. Most vets will work with you by phone, getting updates and making adjustments to meds as needed. Transport is risky with a dog on conservative care. Plus there's even further risk with Oscar getting upset and aggressive at vets. I would speak to the vet to determine exactly what the necessity for any visits would be and strongly advocate for phone call updates unless there is a worsening of condition. Pain returning during a taper of the anti-inflammatory is not a worsening of condition, but rather loss of neuro function would be a worsening of condition.

Likewise with laser or acupuncture, you need to weigh the benefits of the treatment against the risk of transport. It's really only severe cases of IVDD, when a dog is paralyzed, that it would be advisable to transport to alternative treatments. You're doing the best thing right now - the strict crate rest for 8 weeks.

Dogs are very quick to pick up on our feelings so be sure to keep a happy face and voice around Oscar. Tell him every day that he's getting better and you believe it, too! Please let us know what the neuro says after speaking to him about reducing/stopping the pain meds so a better test for pain can be made.

Healing prayers for Oscar.

Mary, hoping to hear the new med LIST will control pain and get the swelling resolved.

What is the dose of prednisone for 7 days?..... is it 2.5 mgs (1/2 of a 5mg tab? 2x/day
Let us know what the mgs and frequency are for the Robaxin

Prednisone has a range of mgs that can be prescribed to deal with inflammation. If this round of 7 days at the lower end of the range still does not get the swelling resolved, advocate for trying the higher end of the range such as 5mgs Prednisone 2x/day. Because the pills come in 5mg size, vets will round up to 5mgs.  We mostly see vets using the higher end of the range to more quickly get results. It usually takes in the range of 7 to 30 days excluding any days below the anti-inflammatory dose to resolve swelling. So far Oscar has had 11 days on the low end.

Mary the body naturally makes it own steroid hormone. When a disc episode happens the level the body produces the steroid is not high enough to deal with spinal cord inflammation. A vet wants to get that swelling down faster so that damage to nerves does not occur. Nerves do not like being pressed on...they react by dying. We see dying as wobbly walking as nerves further deteriorate, dragging legs, loss of bladder control....

So vets use a synthetic steroid and typically at the higher end of the range for the anti-flammatory dose. The taper really is to signal the body to make its own steroid hormone. It just happens that the taper lowering to less than an anti-inflammotory level allows a peak into how well pred has been doing. If pain surfaces on the taper, that lets you and vet know more time on meds back up at the original doses are needed.