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Post by Mary & Oscar on Oct 26, 2016 8:39:42 GMT -7
Hi there, Robxin is 3 X a day 1/4 pill 500 mgs. Started yesterday about 4 pm pred is 2.5mg for the next 7 days then taper. He slept well last night, and went out pooped this morning he stretched after he pooped. We came back inside and he was alter wanted me to rub his belly, Which I haven't been able to do since this all started. Got him a foam pad for his crate this morning. I took him out to pee just a bit ago, he shock off when I put him down. He still seems a little uncomfortable in the mid section area when I rub him, but he is very calm and seems to be sleeping more, is moving some in the crate but lying on his side. Picked up more of his meds. He's not drinking very much, but has water in his crate. From what I gather the pain meds will help him sleep. Going to see how he does today and tomorrow and then give a call to Neuro Since this all started he really has not been himself,other than this morning he was a little playful. Trying to stay positive he has full Neuro function, I'm just worried because if I have to take him to vet or to get reexamination. He's not very nice at the vet, he must have had some trauma before came to us. i was wondering do you have an updated list of Vets in my area Miami, Fl that deal with IVDD? If these meds don't work for him then what next? Is there something other than Pred that can be given to bring down swellings? After 8 was of rest and scare tissue is formed can pain still exist? Just uploaded a pic of him for you all to see. He's resting, and calm.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,608
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Post by PaulaM on Oct 26, 2016 12:12:41 GMT -7
Mary, if you hire a new vet, then you would have to bring Oscar in for an exam. Let's hope you can avoid transporting and that you can advocate for your current vet to work with you on the phone to adjust meds, etc. IF this low end of the anti-flammatory pred doesn't get the pain resolved at the end of 7 days...that is if you see pain surfacing on the taper, then you advocate as strong as you can for using the higher end (5mgs 2x/day). Remind the vet that surgery is not an option for your family. His recent 10/11 bloodwork showed his organs are healthy to use pred. Discuss if a more up to date blood panel is needed IF, if another round of pred should be needed. There are only two classes of anti-inflammtory meds. The steroid class and the non-steroid ones (NSAIDs) The steroid class is the most powerful and the NSAIDs are the lessor class. Dec 6 is to be graduation day. So there is still time to see what Pred can do over the the course of the typical 7-30 days it takes. Remember taper days do not work on swelling and inflammation. This is our member directory: www.dodgerslist.com/literature/surgerycosts.htmConservative treatment works in 8 weeks for the disc to heal, form scar tissue, and often several courses of an anti inflammatory before the painful swelling is resolved. The hope is that the disc will shrink back enough or pieces reaborbed so the spinal cord is not being affected. Some very few times that has been the case pain still existed. For the family either surgery was not an option or the medical health made surgery not an option. In those cases, the vet worked with the owner in managing pain via the miracle of modern medicine at the lowest dose possbile . Just like some people take meds long term to be able to allow living life in comfort.
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Post by Mary & Oscar on Oct 26, 2016 15:43:39 GMT -7
Hi there Thank you I got home to take him out he pooped, but he was reluctant to come out of crate. Picked him up he is very rigid and seems like he is in pain almost like tip toeing with his back legs He did not pee I put a call into neurologist what can I do to help him tonight should I up pain meds or up the pred? I'm at a loss and don't know what to do he hasn't been out of the crate, has been sleeping all day Help if you can advise I have exam Meds
-------- Oct 26, 2016 at 6:18pm
Hello, i spoke to the Neruo, explained that for sure Oscar is in pain, and that he had his pain meds at 4pm and should not be in pain. I explained about the low dose of pred and that I wanted to up the pred to 5mg. She was trying to explain to me that if the pred had not already worked then it probably would not because the swelling goes down after the 1st couple of doses and more than likely we were dealing with disc tissue pressing on cord, and that we would have to look at surgery as an option. She wanted me to bring Oscar in, But I told her a this point what did we have to loose by upping the Pred so finally she agreed. Also she told me to give him 5mg of diazepam. So I gave him the diazepam and pred at 7:15pm . Waiting to see if he falls asleep he has been a little uncomfortable in crate and whinny. Worried about his legs they seem a little weak when he pooped. How long before we can notice a change from the pred? Also, how long should I ask for him to stay on Pred 5mgX 2, would it need to be 7 days?? They told me to call back in morning and they may call in another pain Med to pharmacy don't recall the name.
--------- Oct 26, 2016 at 7:07pm Hi there not feeling good at all. Very stressed.. Oscar is still not comfortable and is in pain. Tried to take him to go pee but he could not and just stood still but legs are very weak. Worried I going to wake up in the night and he's not going to be able to use his legs. What do I do if he's still in pain and his pain meds are due at midnight. Very worried he's been in his crate all the time why would he worsen?? How long before it is an emergency if he does not pee?..
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Post by Julie & Perry on Oct 26, 2016 20:32:38 GMT -7
Hi Mary. So sorry Oscar is in pain. Any chance you could take him in too emergency vet? It's not safe to try to adjust meds by yourself. Maybe the vet could give him something stronger like a fentanyl patch and try to express or catheterize him. Wish I could help. Prayers are with you guys.
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Post by Mary & Oscar on Oct 26, 2016 21:17:09 GMT -7
He finally peeped at about 10:30 I spoke to the Neuro vet and she told me to go ahead and up the dosage of pred, but he,s really weak/ wobbly in the legs. Just gave him his round of pain meds but he gets very upset at the vets. I may need to take him tomorrow if his back legs are so weak but if I can't do surgery will he go paralyzed. What if the vet say he wants to do surgery and I don't do it what option will I have. It has only been 13 months since he had surgery and now he is having just as bad of pain. I can't afford surgery every year, or so.... What are my best options with him? I love him and don't want to see him in pain and I want what's best for him but this is so stressful. I know you understand because of all you are going through with Nala. He is so stressed when goes that I'm not sure what is the best for him. Any advice will help.
[12 lbs Prednisone 5mg tab as of 10/11: 2.5mgs 2x/day for 4 days as of 10/17: taper @ 2.5mgs 2x/day as of 10/25: 2.5mgs 2x/day for 7 days as of 10/26 5mg 2x/day for 7 days Gabapentin 50mgs/mL: 1.2mL 3x/day NOTE: 0.2 x 50mgs=10mgs+ 50mg = 60mgs gabapentin 3x/day Tramadol 25 mg 3/x/day Diazepam 5 mg 3x/day Robaxin 125mgs 3x/day Pepcid AC 5mgs 2x/day]
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Post by Pauliana on Oct 26, 2016 22:18:29 GMT -7
Hi Mary,
It can take from 7 to 30 days on Prednisone at the 5mg 2x/day dose to get the swelling down. Doses below that are not anti inflammatory and wouldn't work on the swelling.. Usually a taper is tried at the 7 day point to see if the swelling is gone.. and pain meds are backed off or stopped for the taper test.. If pain returns, another course back up to the anti inflammatory dose.. until the next taper. It is not unusual at all to have to taper more than once.. Once the swelling is gone, the pain will be gone too and then no further pain meds would be necessary.
Is the Pred dose still 5mg 2x/day? Any other changes to the med list?
He needs his pain meds adjusted, she keeps adjusting the muscle relaxants and not Tramadol or Gabapentin.. Ask her again what pain med she was thinking about adding and remind her that you can't do surgery again so soon!
It takes 8 weeks for secure scar tissue to form over the disc..Nerves can self repair. Once pain is in control it will make all the difference in being able to take care of him.. I know how it is when Vet's are resistant to aggressive pain management. You are doing your best to advocate for Oscar! Keep at it!
REGAINING NEUROLOGICAL FUNCTION has no time limit for nerves to heal. Nerve repair is individual as each injury is different and each dog’s ability to heal is different. If deep pain perception (DPP) is present, even in paralyzed legs, there is a chance your dog may be able to walk again. For those dogs who have lost DPP, do know nerve regeneration can take place and that function may return. Once deep pain perception is regained, your dog has a chance at a walking recovery. Thousands of dogs on Dodgerslist have regained functions in as little as 2 weeks, others 11 months, and still others 3 years later. IVDD is a disease of patience to allow the body to heal on its own terms.
Once nerves have repaired then muscles will also have to be retrained to relearn proper placement of the paws. Some muscles will need to regain strength for walking. Consider learning to walk again as it would be for a stroke victim or a baby learning to walk. At first, the steps will be weak and a bit unstable. Relearning to walk takes coordination, building up strength, and lots of patience.
There is no timetable anyone can give you when to expect nerve repair to happen. In fact, there is no time limit for nerves to heal...it can take weeks to more like a year or even longer. However, it is known that neurological function usually returns in the reverse order of the damage. The first big sign you want to look for is that wonderful tail wag!
1. Deep Pain Sensation (Only correctly identified by a specialist.)
2. Tail wagging with joy at seeing you, getting a treat or due to your happy talk.
3. Bladder and bowel control proved by passing the "sniff and pee" test.
Take your dog out to an old pee spot in the grass. Let him sniff and then observe for release of urine.
4. Leg movement, and then ability to move up into a standing position, and then wobbly walking.
5. Being able to walk with more steadiness and properly placed paws.
6. Ability to walk unassisted and perhaps even run.
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Post by Mary & Oscar on Oct 27, 2016 2:48:10 GMT -7
GM We just started the 5mg [Prednisone] last night [10/26] he was only getting 2.5mgs X 2 but I finally got them covience to move him up when he was in so much pain. This morning I just took him to poop I took him out. He is not rigid this morning was able too poop on his own did not pee, but did stand and he did take a couple steps but is wobble walking. He is wagging his tale. Waiting to be seen by vet is that a mistake. Last night he had both diazepam and Robxin at midnight along with tramadol and gabiptin.
Is he going to continue to get worse, before he gets better, what do I do if they want me to bring him in? He stand and full Neuro function this whole time now I'm starting to see more weakness. Is what the vet said last night true that swelling is not what's causing the issue is the debred from the disc and that won't go away? Am I wrong for not doing the surgery, I don't want him to suffer. please advice.
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Post by Julie & Perry on Oct 27, 2016 4:18:29 GMT -7
Mary, I'm not a vet but Oscar's Gabapentin dosage seems low to me. My Nala is 13 lbs and takes 100 mg 3x a day. Talk to your vet about adjusting his dose. Nala had trouble with pain also and I really had to push. General weakness from crate rest is not something I'd worry about right now. Thinking of you and Oscar.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Oct 27, 2016 4:50:40 GMT -7
Hi, Mary. I'm glad to hear that the vet has moved Oscar up to a higher level of Prednisone, which will better work on resolving the swelling that's pressing on the nerves of the spine. Swelling can take 7-30 days to resolve. And yes, there most likely is also disc material that has bulged out of the damaged disc that's pressing on the spine. That also can resolve with conservative care with the very strict limitation of movement of the spine. The body can reabsorb that bulging disc material.
With the only neuro symptom being wobbly walking, Oscar is a good candidate for conservative care. You are not wrong to not do the surgery. You've chosen the less invasive treatment. Your main goal right now is to be sure to continue to restrict the movement of his spine by carrying him in and out to potty with very few steps at potty time. And also to be sure that his pain is completely under control. As Julie mentioned, the vet can move up on the dosage of the Gabapentin and can also increase the dosage of the Tramadol. So if you see any sign of pain today, please do call the vet and advocate strongly for an adjustment of pain meds.
You mentioned twice now that you took Oscar out to pee but he didn't pee. Is he still able to urinate on his own when you take him outside? Are you finding wet bedding or is he leaking on you when you lift him up?
As Julie mentioned, the weakness that you're seeing in Oscar's hind legs may be due to being inactive in his crate. Muscle loss comes back quickly after the 8 weeks of crate rest are over so don't be concerned if his legs are a little weak.
I know it's difficult to have Oscar going through a second incident only 13 months after his surgery. My Jeremy also had a second incident occur within 2 years following his surgery. He was able to recover from his second incident with conservative care. It has now been over three years since his second episode and he's had no further problems.
You're doing a great job with Oscar and did the right thing getting him on the higher level of Prednisone. Try to take it one day at a time and not worry about what might or might not happen in the future. We can learn so much from our dogs who know how to live in the moment. You're the captain of Oscar's medical team and you're doing a great job working with your vet to get Oscar the care he needs. We're here for you and will continue to help you and Oscar through this.
Healing prayers for Oscar and some hugs for you.
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Post by Mary & Oscar on Oct 27, 2016 5:06:57 GMT -7
Hi Marjorie Thank you for your words. He peeped at 10 pm last night. Gave him both diazepam and Robxin at midnight and this morning. Along with tramadol and the gab. Going to call this morning but they mentioned they may want a o see him and it is so stressful on him.
He's taking 1.2ml X3 times Adam what does that add up too? Is there a conversion? going to try to get him to go out and pee this morning. just took him out at 8:45 Am he sniffed and pee, brought him right back in. He is resting now. But he is rigid in stomach area. Waiting on call back from Dr. Going to speak about increasing dose of pain meds. Thanks everyone.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Oct 27, 2016 6:17:18 GMT -7
You had mentioned that the Gabapentin was 50 mg 3x/day - is that correct? It's hard to convert ml to mg. When you speak to the vet today, ask how many mgs of Gabapentin is being given if you only have the dosage in mls. Yes, a tight, tense tummy is a sign of pain so do speak to the vet about adjusting pain meds. Be strong in telling the vet that you don't want to bring Oscar in because he gets so upset and you're concerned that he will injure himself more and that you just need an adjustment of pain meds. Transport is also a risk that isn't needed to adjust meds - that can be done by phone. Tramadol 3 to 5 mg/kg (0.5 to 2.5 mg/lb) every 8 hrs to QID (up to 6 times daily at lower dose) Anecdotal reports include 10 mg/kg QID for more severe pain vasg.org/t_drugs.htm#TRAMWe'll be looking forward to an update once you speak to the vet.
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Post by Mary & Oscar on Oct 27, 2016 7:41:06 GMT -7
Hi Everyone Just got off the phone with Neuro. She is ok with him being on the 5mg X 2 a day fo now but does not want to do if for long. Don't think I get her to agree to let him stay on past Monday which will be 5days but I'll try for 7 days. She says that she doesn't think the pred is not going to really help, but is willing to let me try. She talked about staggering his pain Meds instead of giving them all at once. She doesn't want to add or change anything other then the pred right now so she can see what is going on with him. If he's still having issues with pain on Monday then she may add a pain drug called Antidin.she said the Gabaptin is 60 mgs.
[12 lbs Prednisone 5mg tab as of 10/11: 2.5mgs 2x/day for 4 days as of 10/17: taper @ 2.5mgs 2x/day as of 10/25: 2.5mgs 2x/day for 7 days as of 10/26: 5mg 2x/day for 5 days Gabapentin 50mgs/mL: 1.2mL 3x/day NOTE: 0.2 x 50mgs=10mgs+ 50mg = 60mgs gabapentin 3x/day Tramadol 25 mg 3/x/day Diazepam 5mgs 3x/day Robaxin 125mgs 3x/day Pepcid AC 5mgs 2x/day]
She also talked about meningitis and how they also can't rule that out without MRI.. Oscar had his Rabbies vaccine on Sept 29, and they told me it could be a possibility that a dog could get that from a vacine. She wants to take it one step at a time she said for sure we will talk on Monday and try to come up with a game plan and if need tomorrow. Oscar is sleeping in his crate and my husband will be home all day to keep an eye on him today. Thank you for explaining about his legs. When should I worry about his gate or walking. She agree to wait and see him for now, but told me it's an emergency if he starts dragging or stops moving. All advice is much appreciated
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,608
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Post by PaulaM on Oct 27, 2016 8:35:15 GMT -7
Mary, good job on advocating for getting prednisone up at the higher end of the anti-inflammatory range we typically see vets using with a disc episode PLUS not having to risk transport for a visit. Really hope to hear that some stride will be made now and that a 5-day course can get the swelling resolved.
As Marjorie pointed out Tramadol has much room to move up in mgs so you could phone in and strongly advocate for 50mgs 3x/day for a 5.44kg dog if the current med LIST is not providing full pain. The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours. Veterinary pharmacologist Bruce KuKanich, DVM, PhD, DACVCP explains why the 25mgs 3x/day may not be fully controllilng pain:
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Post by Mary & Oscar on Oct 27, 2016 8:53:38 GMT -7
Hi tyere she also wants me to give Diazepam 5mgs X 3. He is in crate a little whinny but will try to stager meds like she suggested. Trying to figure out which one to give at a different times any suggestions Do you know what the other Med is she wants to start if no change its called Antidin?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,608
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Post by PaulaM on Oct 27, 2016 9:45:04 GMT -7
Mary we encourage members to Google each med their dog is on or might be on. When you Googled "Antidin" did you come up with the stomach protector whose generic name is Randitidine? I don't think you have the spelling correct. Being on Pepcid AC (famtodiine) is the better protector, the newer generation over Randitine. And of course a stomach protector is not a pain med. Dr. Galle, Neurology (ACVIM) reports: Research studies have found that when when given together gabapentin and tramadol can enhance the effect of each other; therefore, giving the two drugs together may have an advantage for treating inflammatory pain. From the Dodgerslist neuro corner: www.dodgerslist.com/neurocorner2/timingmeds.htm
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Post by Mary & Oscar on Oct 27, 2016 10:13:07 GMT -7
Ok I will find out about med when it is prescribe. To many other things to worry about for now. OK that so I going to give TRamdol and Gab with Robix then give diazipam about an 1hr later. then he gets the pred at 7. I was wondering what is your opinion on the laser therapy and when should it be stated... Does it help with mostly pain or only for when a dog is paralyzed? I will be home tomorrow and the weekend with him so I will be able to monitor more. Also, marjorie and the other lady said I shouldn't be concern right now with Wobble walking even though that is something new... He was fully intact/Walking yesterday. He still standing and wants to walk, thats good right? I only let him take a couple of steps then back in crate. Vet said it is an emergency if he starts dragging legs or knuckling.... When should I really start to worry about his walking??? Last time he has ok one day and then the next he was dragging his legs. I am doing everything I can for him and trying to figure out the pain meds. I just want for him to be comfortable. The Vet said it is an emergency if he drags his legs. What do you think about the meningitis, question. Im not sold that it could be that.... I have to go to work. Will post later to give update should be home around 7:30
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Post by Julie & Perry on Oct 27, 2016 10:55:07 GMT -7
Hi Mary. How's Oscar's pain? If it's not under control tell your vet you want the dose upped until it is. There's no reason for Oscar to be in pain. If you're giving Prednisone at 7 be sure to give stomach protection pill at 6:30. Steroids cause more stomach acid which can cause ulcers. The stomach protection pill reduces the acid. Make sure you give the Prednisone with a little food to further protect the stomach. I actually just started cold laser therapy for Nala. It was $300 for 9 treatments. I put it on Care credit. No interest if repaid in 6 months. You can start laser therapy at any time. Just be careful in transport. Nala's crate is padded with blankets to protect her and I hold her on the table while she has her treatment. It's supposed to help with reducing inflammation and increasing blood flow to promote healing. It's too early to tell but other members have said it helped. Good luck.
Gabapentin and Tramadol could be increased.
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Post by Romy & Frankie on Oct 27, 2016 14:17:54 GMT -7
If you think that Oscar's condition is worsening that is something the vet should be made aware of right away. If I am correct in thinking he was walking fine yesterday and has just started to wobbly walk that is of concern. Is it wobbly walking or just a general weakness in the legs?
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Post by Mary & Oscar on Oct 28, 2016 5:29:34 GMT -7
GM Everyone, Oscar rested last night well. Staggering the meds to see if that keeps him comfortable. He's eating well. Last night I took him out to pee about mid night he did his usual. Took a few step and stood on all fours he's moving slow, but was able to take steps and stand on his own. I would say he's definitely weaker than a few days ago. After bringing him back inside, I watched him he was standing in his crate and fixing his blanket, and seem to be moving around. He did not seem to in pain, and was not rigid like Wednesday. This morning he got up took him out and at first he was a little wobbly on his feet but then he started moving better again. He pooped and then I picked him up and brought him back inside. I am trying to let him rest as much as I can and stagger the meds. He's very calm and I would say pretty drugged up. He usually sleeps a lot so I'm happy he's resting I can here him breathing. Going to see how he is with legs today to see if weakness or wording. Here are my questions/ concerns for this morning.... 1. The doctors really want to taper pred on Monday or Tuesday, I'm really worried he's going to get worse. Dose this ultimately mean he needs surgery? 2. Spoke to holistic vet and they would need me to bring him for a consult for then to evaluate him, is that a good idea or not? 3. Neuro wants to see him back next week if he's the same should I take him, worried they won't give me anymore meds without seeing him because the primary vet is out of town. Your thoughts are always welcome
10/27 update: I don't know when I get home I will see he is only out of the crate to pee and poop and this morning he was standing but and when he went to walk his legs walk but it was not straight. My husband is home and he is going to let him out but I'm not sure he says hes been quite all day.. has had his meds and is going to eat and I should get home in an hr or there abouts.
Hi there everyone he has been quiet for most of the day my husband says He's usually not home with him but did say he ate well and took all his meds we staggered them, so let's see f that helps I did ask about the pain meds being up she wanted me to stargger them to see if we would get a better affect. They didn't want to add or change anything this just yet. I will talk to them if need tomorrow. He went out to pee squatted when he peeped with my husband he stood up when put down he took a couple of steps and the he picked him up. He saw him this morning to and he said he did not think he was wobbling when he went out this time.
Although he did say when getting out of the crate he couldn't push his back legs up to step out of the crate which he was doing before. Seems weak on the back side I am home all day tomorrow so I will be able to see what is going on with him. Trying not to stress so much haven't slept in days. Lol Praying we make it through the weekend and we can get the pain under control. Today he did seem in less pain i did find another vet in Miami that does holistic vet Med. Like laser and acupuncture. So I have some option with them if need. He is sleeping in his crate right now. Was alert when I came home in the crate. He's very calm, i will take him out for a poop later tonight to see how he is.
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Marjorie
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Member since 2011. Surgery & Conservative
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Post by Marjorie on Oct 28, 2016 8:43:36 GMT -7
I'm very glad to hear that Oscar rested well last night, Mary, and that his pain seems to be now under control. Moving slowly could be a sign of pain but it could also just be because he's not steady on his feet. You usually can confirm pain if you're seeing two or more signs of pain so keep your eye out for any other sign of pain and if you see any, let the vet know. But it does sound as though he's doing much better now.
As for the weakness, their legs can weaken from being in the crate. It's encouraging to hear that he was a little wobbly on his feet but then started moving better again once he got his feet going. Do try to keep those steps to a very, very few at potty time to protect his spine from further damage. Too much movement and the damaged disc could tear more. So it's best not to let him walk to see how he's walking - a few steps should be all it takes to do his business and to assess his leg movement.
Hopefully by Monday or Tuesday, the swelling will have resolved and this taper of the pred will not show a return of pain. Usually a vet will also taper or stop all pain meds so a true test for pain can be made. Otherwise, the pain meds will mask any sign of pain and you need to see if there is pain in order to determine whether there is still swelling/disc material pressing on the nerves of the spine. Pain = swelling = more time on original dosages of all meds. So do speak to the vet about stopping or tapering pain meds during the taper of the Prednisone. Continue to give the Pepcid AC twice a day for as long as Oscar is on the Prednisone, even during the taper.
If this taper of the Prednisone doesn't work and pain/swelling is still present, that does not mean that surgery is necessary. It can take 7-30 days for swelling to resolve and during that time, the anti-inflammatory level of the Prednisone needs to be given.
Advocate strongly to continue to monitor Oscar's status and adjustment of meds by phone with the vet to allow Oscar to remain resting in his crate.
Laser and acupuncture are helpful for paralyzed dogs but Oscar is only showing mild symptoms of IVDD and is still walking. Transport is risky and you need to weigh the benefits of the treatment against the risk of transporting and moving Oscar. You're doing the most important thing already - the strict crate rest and meds.
Stay strong and stay positive! Continued prayers.
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Post by Mary & Oscar on Oct 29, 2016 6:16:59 GMT -7
GM So, Oscar seems to be resting better, eating well. I took him out to poop last night and he needed to go right away, but it seemed like it was difficult to hunch over. His is standing on his legs and does take a few steps. He woke up this morning took him out to pee and was a little wobbly but then got his footing. Does not seem to be rigid or in pain. Then a little later he needed to poop so again I took him out just stood for a minute and then he seemed like he needed to go but again he had a hard time hunching to poop. It seems like weakness, but I'm not sure if it's weakness from the disk pressing on his spine or weakness from being in the crate? Should I be worried I know the neurologist is all about the surgery, but I really want to try and continue with this path of conservative treatment. As long as he has feeling and movement he could make a full recovery, right, and from what I read they can make a full recovery even if they loss movement. My concerns with Oscar.... are he only had surgery a year ago and we are already with another episode and from what I see on this blog and Facebook dogs that have multiple episodes are at higher risk of reoccurrence again anyway. Even if you are cautious with them. It doesn't seem like he's loosing the ability to poop it seems like he's just very weak. Could it also be from all meds he's taking or is it more likely that the swelling is still there and or there is disk material damaging the cord. I know non of you or I can really answer that because you don't have MRI vision. He is more alter today and his muscles are mor relaxed.Thank you to everyone for your advice sorry if I'm asking similar questions each day but this is so difficult and I am trying to do all I can for him. Sojust took him out too pee and he does seem weaker in the legs and was wobbling in back legs... What to do should I call Neuro or wait? ... 10:49 Am
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,608
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Post by PaulaM on Oct 29, 2016 9:00:21 GMT -7
Mary, that is good news≠ he is NOT in pain. When he does poop are his poops rather firm? Tramadol can cause constipation. Plain pureed canned pumpkin is high fiber and can firm up stools and help with diarrhea or loosen the stool to help with constipation. The amount of water in the diet makes all the difference. NOTE: alternatives are really ripe mashed fresh pear, just take off the peel off; microwaved and mashed peeled sweet potatoe. -- To loosen the stool, add equal parts water to each kibble meal and soak overnight. At mealtime add one teaspoon of plain canned pureed pumpkin 1x a day. -- To firm up the stool add 1 teaspoon plain canned pureed pumpkin 1x a day to kibble and no extra soaking water to the kibble. It is difficult thru the written word to know exactly what you are observing with "wobbly" Could be muscle weakness from not using the muscles much. Neuro diminishment involves: --- not being able to place the paw correctly on the floor called knuckling. When he is standing say at potty time anyway, you might try to bend his back paw back and see if he tries to correct it right way or slow to put his paw back in position. --- When he takes a footsteps at potty time does he drag his nails, that is he is not lifting his back paws off the ground in a normal footstep. --- When standing do his back legs cross. The spinal cord does not like getting pressured. The disc bulging out of shape can invade the spinal cord canal squeezing the cord. Also a disc can tear and allow some pieces to escape from inside the disc. Those pieces end up in the canal pressing on the cord. Inflammation results...inflammation is swelling and more pressure to the cord. With too much pressure, the nerves react by dying. We see that dying as neuro diminishment. Conservative treatment very often does work with prednisone used at the higher end of the anti-inflammatory dose, during the course of 7-30 days to resolve swelling. The hope is that the body will also absorb enough of any disc pieces that may have escaped to shrink back enough to no longer cause pain/damage to the cord. It is only now in the past days that the high end of the anti-inflammatory range (5mg 2x/day) has been in effect and that course has been Rx'd for 5 days. Getting pain in control and managed dose to dose through proper pain med use is the goal in allowing Conservative Treatment to proceed. You have had experience with surgery. However, you may wish to review the all the details between conservative and surgery towards the end of this very informative info. It may help you to better advocate or present your thoughts to your vet in getting help for Oscar. www.dodgerslist.com/literature/healingsurgery.htmThere are no guarantees with either surgery nor conservative treatment. A number of surgeons see a disc episode most always a surgical answer. Some few go very soon to surgery while others want to try least invasive method first-- conservative treatment as long as pain can be in control. Some surgeons have a great deal of practical experience with conservative treatment while others have little practical experience. I have nothing against surgery as I see everyday here on the Forum how much good it can do. My Clark is an example of the unexpected risk of a surgery. I will never know if the opting for conservative treatment instead of a 2nd time surgery would have had him walking. The 2nd surgery caused a weakness in the vertebral bone and the fracture that collapsed on to the cord. The 3rd surgery was to make a bridge to support the vertebrae with not much hope the cord would be able to self repair. Clark has adapted to scooting in the house and his wheelchair for outdoors. He is still very much the same happy boy as he was 9 years ago before the unexpected surgical outcome. It is good to keep asking questions and continue to read til you have in your heart and mind what you desire for Oscar and are able to get that message across to a vet willing to help. There is no right or wrong choice. Keep in mind having deep pain sensation, the very last of the neuro functions to remain, is an indicator that nerves would have the ability after a surgery or with conservative treatment to self repair. When and how long is a matter of time and patience. Some dogs have self repaired nerves even close to a year out of being paralyzed and were able to walk again. I would report to the neuro any signs of neuro diminishment. Some vets would want to try a different steroid. Some steroids are stronger than others. Use of a stronger steroid is considered when surgery is not an option that it might be able to get the swelling down faster. Dexamethasone is one steroid.
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Post by Mary & Oscar on Oct 29, 2016 18:56:01 GMT -7
Hi everyone, I called the Neuro today and told him about the weakness in his legs and of course he said it is more than likely going to need surgery. So I read a lot today and called the holistic vet that was recommended to me that does cold laser therapy. So we took Oscar and we did our 1st of seven sessions. Here's the thing I just want to do everything I can for him and try to avoid surgery. So I'll let you know how it goes. I know there is a risk with transport but at this point I feel I must try. Given this is his second episode in just a year. She felt she could help him so I'll keep you posted. If it doesn't work or he get worse then I'll have see what is next. She is having me put him on
[12 lbs Prednisone 5mg tab as of 10/11: 2.5mgs 2x/day for 4 days as of 10/17: taper @ 2.5mgs 2x/day as of 10/25: 2.5mgs 2x/day for 7 days as of 10/26: 5mg 2x/day for 5 days Gabapentin 60mgs 3x/day Tramadol 25 mg 3/x/day Diazepam 5mgs 3x/day Robaxin 125mgs 3x/day Pepcid AC 5mgs 2x/day] Prilosec 20mg 1/2 tablet once aday just to also help protect his stomach Vitamin E 400 IU: 100mg once a day start with 1/4
7 treatments of laser, 3 days straight, 1wk for three weeks, 1 in two weeks She told me to communicate with the Neuro and to continue with meds.
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Post by Mary & Oscar on Oct 31, 2016 14:31:32 GMT -7
Hi Everyone, glad we made it past the weekend. Oscar has had a ruff night and morning. he went out to pee and pooped, but it was difficult pushing himself out of that position of squatting and hunching so, I needed to help him. Ate this morning, and took all of his meds. Then went out again to pee earlier this morning but he is really weak in the back legs and wobbly had to give him a little support. He still can place his paws on the ground, but when he goes to take a step he is really having a hard time keeping his footing. I am afraid he may fall so I stay right there with him. I Called the vet and neurologist both said he is on the highest of meds for pain he can have and that they would see him tomorrow. I also, told them about his legs. Im sure they will reassess tomorrow. He has also been peeing alot and seems to be drinking alot. He went three times in a few hours. He also, had an upset stomach today after a treat which I believe made him through up. Really worried surgery may have to be a considered. Just dont want him to go down on me. Keeping a close eye on him. Not sure what to do or how I'm going to handle if vet say he needs it. Are there any other documents out there on 2nd and surgeries are the risk higher? Whats the worst thing that could happen if I wait and dont do the surgery. Paralyzes..... Any thoughts advice will help
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Post by Romy & Frankie on Oct 31, 2016 15:43:51 GMT -7
I am concerned that Oscar's pain is still not under control. Vets have a lot of options when treating pain. You could advocate for an increased dose of tramadol.
Plumb's is the veterinary bible regarding drugs: Tramadol dosing in dogs varies, ranging from 2 to 5 mg/kg every 8-12 hours. The highest dose for maximum analgesic effect in dogs is 10 mg/kg every 8 hours. “Tramadol”. Plumb DC. In Plumb DC (ed): Plumb’s Veterinary Drug Handbook, 7th ed—Ames: Wiley-Blackwell, 2011, pp 1002-1004.
The usual in controlling pain is to Rx at the higher end of the mg range AND promptly every 8 hours . If thereis pain the meds are not yet right and need to be tweaked until the pain is under control.
We are not vets and do not know the specifics of each dog's health. We are making this suggestion based on what we've seen qualified vets prescribe in the past and only as a basis for discussion with your vet.
The peeing is due to the pred which cause increased thirst and therefore increased urination.
Surgery is not the only option if it is not within your means. You can continue the crate rest and anti-inflammatories. Dogs on this list have had 2nd surgeries. I have not heard that these surgeries were more risky. What is most important now is that Oscar's pain gets under control.
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Post by Julie & Perry on Oct 31, 2016 16:48:39 GMT -7
So sorry Oscar is in pain. Hope your vet is proactive and willing to work hard to get it under control. Will be sending you both healing thoughts and prayers. Hang in there. It will get better.
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Post by Mary & Oscar on Nov 1, 2016 14:51:58 GMT -7
Hi Everyone, Well we made it back home from Nuero with Oscar. He assessed him and felt he was at a level 2 out of 5 at this point in his neurologic function. He felt his pain level was way down from 2 wks ago from a 7 to a 3 out of 10 [pain]. We did talk about all the options and he was ok with taking it day by day. He felt that if Oscar could not stand at all and loss function of his legs then at that point we would really need to go with surgery. Hewants to take away the Robxin muscle relaxers to see if his gate would improve, and we are going to do the pred at this higher does a few more days then start to taper.
[12 lbs Prednisone 5mg tab as of 10/11: 2.5mgs 2x/day for 4 days as of 10/17: 2.5mgs 2x/day as of 10/25: 2.5mgs 2x/day for 7 days as of 10/26: 5mg 2x/day for 7 days, then taper Gabapentin 60mgs 3x/day Tramadol 25 mg 3/x/day Diazepam 5mgs 3x/day Robaxin 125mgs 3x/day STOPPED 11/1 Pepcid AC 5mgs 2x/day Prilosec 20mg 1x/day]
He encourage us to continue the cold laser and if possible to start acupuncture. If Oscar would tolerate it. He felt that [acupuncture] can help with the muscle spasm.He's going to give me a call on Thursday see how he's doing and will go from there. I praying we continuing down this path of healing. We took him to get a cold laser treat while we were out. So now he's home resting. I am using the sling to help him stay steady on his feet. Thank you for all your words of support and advice it is much appreciate. Today makers 3 weeks of crate rest.
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Post by Romy & Frankie on Nov 1, 2016 15:19:19 GMT -7
To make sure we have it right, Oscar will be continue taking pred at 5 mg 2X a day, correct? Is Oscar's pain now completely under control? In your last post he seemed to be still having pain. Although his gait may improve if he stops taking Roboxin, his pain may get worse. If that happens, you should let the vet know right away so he can start taking it again. If you are planning to add acupuncture to his treatments, you may be able to get the treatments at home. This way, Oscar would not have to be transported. We have some listings for acupuncture vets here: www.holisticvetlist.comwww.aava.org/search/custom.asp?id=1530www.ivas.org/Healing thoughts for Oscar.
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Post by Mary & Oscar on Nov 1, 2016 16:31:10 GMT -7
Yes the pred is going to continue [for how many days?]. We will is really hard to tell at times because he is such a quit dog but I think so. If the pain resurfaces then we will go back on Robxin. He wants to get rid of at least one of the muscle relaxers so we went with that. We will speak again on Thrusday. He feels that there is still a chance to avoid surgery if he continues on this path, but if he were to regress then may need to revisit the surgery option.
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,608
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Post by PaulaM on Nov 1, 2016 17:57:55 GMT -7
Mary for how many days was the prednisone 5mg 2x/day extended?
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