Gina's Dukie 10/24 conservative relapse NECK —Puggle

Gina, I'm sorry your Dukie is having to deal with pain. We can best help when we know the specifics.  100% STRICT rest 24/7 for the full 8 weeks, only out for a very, very few footsteps at potty time is to avoid a surgery. All hope is not lost, once you understand the disease, then you can protect him from well meaning folk who give harmful advice and you can be committed to following though on crate rest.  As Julie says it is important to read.  Here's the IVDD 101 page on how conservative treatment works...look for the yellow button as your start point and then the other buttons as you can in the next days:  www.dodgerslist.com/literature/healingpage.htm

★ What specifically was meant by going down hill...pain only or any diminishment of neuro fuction, wobbly walking, dragging legs, paws knuckle under?
Did the vet believe the problem was in the neck or the back?
★2 What are the credentials of the 2nd opinioin vet.... Is the vet a general DVM or a specialist surgeon (ACVIM neurology or ACVS ortho)?
     I want to share with you some new information about a pug disease where for unknown reasons lesions develop and constrict the spinal cord. There is little known about Pug Myelopathy. Check out Dr. Smiler's webpage and bring this information to the table for discussion with your own vet: pugrearataxiaparalysis.com As always getting the right diagnosis is important to implementing the right treatment and having an idea of expectations.

★3 IF this is indeed involving a bad disc, then limited movement of the neck and back is how that disc is going to heal and form strong scar tissue.
        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.  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!

★4 Tell us what you are specifically observing regarding 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. 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. If not in control your vet needs to know asap to adjust meds.
★5 How much does your dog weigh? Please list the exact names of meds currently given, their doses in mg’s and times per day given?
   Name of steroid started on:  ?mgs    ?x/day    for how many days, the taper
   Name of pain meds  ?mgs ?x/day
Please include the all important stomach protector such as Pepcid AC when taking any anti-inflammatory med (steroid or NSAID). 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.
★6 Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood?

Gina, from what you describe of head down sounds like it is a neck disc. They are extremely painful. These are the extra things you can do at home to help Dukie.  www.dodgerslist.com/literature/cervical.htm

Dukie can't heal his disc if you do not put him inside a recovery suite.  He is doomed to pain and quite possibly the potential to loose leg and bladder functions.  CRATE REST is so very critical for the early healing relapsed disc so it does not move to damage of the nerves in the spinal cord.

A wire crate, a baby crib, an ex-pen are example of recovery suites.  Please make it a priority to protect Dukie's disc and spinal cord.  The subject line shows you are starting true conservative treatment of the relapsed disc today, Oct 24.  Here is how to implement the essential  proper crate rest:  www.dodgerslist.com/literature/CrateRRP.htm

Watiing until a Wed appointment while Dukie is suffering needlessly with pain is not fair to him. Do what you can to quickly get back with the original vet via phone call and tell them of the relapse because of release from crate rest.  If need be go to ER tonight for help with the meds: 

1.
NOW IS NOT THE TIME TO taper PREDNISONE.  Adovcate that pred be back up on the anti-inflammatory dose of 10 mgs 2x/day (every 12 hours)  Tapering days of 1x/day (every 24 hours) does not help get the swelling down.

2.
Methocarbamol ?mgs is a full tablet?  3x/day   If the dose happens to be 50mgs 3x/day that is a very low dose. Advocate for a higher dose 3x/day

3.
Gabapentin 100mg every 12 hours  Look for this med to be Rx'd more often---- 3x/day

4.
Famotidine 20mg 2x/day (every 12 hours)   With the stress of pain added to the acids pred causes, 

5.
Tramadol   as with the above two pain meds (gabapentin & methocarbamol) this one also has a short half life. The usual in controlling pain is to Rx Tramadol at the higher end of the mg range AND promptly every 8 hours.  Advocate for the vet to Rx Tramadol at at least 100mgs 3x/day (every 8 hours).
It is important to know the credentials of any vet you see.  IF it is a local clinic chances are the vet is a general DVM vet.  Usually large hospitals or university vet schools have the specialists.   Most diagnosis of a disc episode do not come from an xray nor an MRI.  The vet with their hands on neuro exam, the breed of the dog and the dog's history are the usual tools of making the diagnosis.  

Seeing a specialist , neuro (ACVIM) or orth (ACVS)  would be good to discuss the possibility of Pug Myelopathy sine he has pug in him. www.pugrearataxiaparalysis.com  Since it is a newly identified disease, not all general vets are aware of it.

The pain meds are not yet right. When the meds are right, then pain is in control in an hour or less. The pain will stay fully under control when moving for potty or repositioning in the recovery suite. Do you have him in a suite now?

When the pain meds are correctly prescribed to stay at the right level in the body throughout the day there will be no pain nearing the next dose of pain meds. With IVDD pain meds it is very likely pain would not be managed unless they have been Rx'd for three times a day (every 8 hours.) Methocarbamol, tramadol and gabapentin, do not last very long, hence why vets who know iVDD, Rx them for 3x/day.

Each time the back or the neck has to move it will cause the vertebrae to push on the early healing disc. Scar tissue takes 8 weeks to heal. The recovery suite is like a cast for a broken arm. The recovery suite limits movement so as not to cause a relapse to the weak and early forming scar tissue..

ADDED: what can you do to get Dukie help tonight with pain?  What is your city state?

Gina, excellent you now have him in the recovery suite to protect the disc and prevent damage to the spinal cord...that is the single most important thing you can do outside of getting the pain back in 100% control.

Pain meds target a different source of pain. All three pain meds need to be back on board need you to advocate for a 3x/day Rx.  Neck discs are typically more painful than those in the back, thus the reason all three meds are prescribed: 
-- Methocarbamol to address painful muscle contractions
-- Gabapentin to address pain from nerves
-- Tramadol as the general analgesic

Prednisone will resolve pain but it takes many days. Often somewhere in the range of 7 to 30 days. In the meantime real actual pain meds need to be on board. Pain meds work in one hour. And when at the right dose, the right 3x/day, they keep pain at bay fully right to the next dose. Pain deters healing not to mention it is pure misery, so that is what we are so adamant about finding a vet who understands the need for good pain control.
Prednisone and how it works on swelling, how many days, what to observe for on the pred taper and more is the kind of information to have under your belt when discussing things with a vet. Some members like to print out and highlight the points to remember ....here is the link on how anti-inflammatory drugs like Prednisone work:  
 www.dodgerslist.com/literature/healingsweling.htm

At a vet visit lots of information flies in a short amount of time. Coming prepared to a vet visit means you can ask the right questions when you don't understand, you are able to ask questions to learn the "why" behind what a vet has prescribed.
    The goal of our Forum is to support you, to teach you how to learn to look up things, question everything and read so you become the most important part of your dog's health care team.  You become the captain of the health care team. So naturally, as the Captain you will want to be an integral part of making decisions and work closely with the vet you have hired. Dr. Nancy Kay, DVM, ACVIM highly recommends this kind of relationship with your vet: "Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain!" www.speakingforspot.com/PDF/Medical%20Advocacy%20101.pdf

You may wish to check out our Member vet recommendations.  www.dodgerslist.com/literature/surgerycosts.htm  Not only can a specialist be consulted about surgery, but they can be consulted about getting the right meds on board when doing conservative treatment, find out if the newly identified "Pug Myelopathy" is involved with this current pain problem. 

Do let us know that you have found the quickest way to get the pain meds adjusted this morning for Dukie...that is the priority.  With pain that means there is still spinal cord swelling and the need for prednisone to go back up to the original anti-inflammatory dose 2x/day.

Gina, a responsible vet shouldn't mind if you say, " I've been doing some research on a website dedicated to IVDD. This is their recommendation based on many IVDD cases and according to vets familiar with IVDD." If they haven't heard of Dodger's List feel free to share it with them. It's a valuable resource. A good book you can get also is called, " Speaking for Spot."

Is there a way to upload pictures? I feel like maybe the crate I bought might be too big. I'd like an opinion if I should get a smaller one or if this is ok. He's able to walk like 2 full steps inside the cage before turning around is that OK?
Thanks

I can't figure out how to delete either lol I looked at the picture you have on this forum and I see the dog has a good amount of room so I'm sure dukie is fine sorry I'm worrying over every little thing haha

Gina, sounds like Dukie recovery suite is the right size....he is able to lie down and fully stretch out the legs. Any extra room could be padded out wth a rolled up blanket if you think he has too much room.

We'd love to have a picture of Dukie. First it would need to be uploaded to a server. You can upload the JPG to our Dodgerslist Gallery. Then all you need to do is copy/paste the picture's address in to your next post.

LOGIN to the Photo Gallery: 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