Charlotte's Toni 4/1 relapse Conservative

Welcome to Dodgerslist, Charlotte!  First thing to know is that it IS in the cards for your Toni to get back to enjoying life whether immediately walking during the short 8 weeks of conservative treatment it will take a disc to heal or waiting on more nerve repair - IVDD is not a death sentence. Find out why that is true: www.dodgerslist.com/index/SDUNCANquality.htm

In order to help you more, could you please answer these questions?

☐  Is the vet a general DVM or a specialist (ACVIM neurology or ACVS ortho)?

☐ What was the exact date you first saw the vet for this disc episode?

☐ 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. 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 crating Toni with Nathan , maybe set up another crate next to Toni for Nathan..
- 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.

www.dodgerslist.com/literature/slingwalk.jpg

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!

☐ Is there still currently 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, restless, can't find a comfortable position. Ears pinned back, 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 of correctly Rx/d pain meds.
Any signs of pain should be reported to the Vet so the medications can be adjusted.  Ask the Vet when you should stop the Tramadol and Neurontin. 

When the pain medications are stopped watch for signs of pain, if pain happens, that means the swelling is not gone and it might be time for Oral Prednisone and Tramadol and Neurontin  should be restarted.   If no pain happens that means the swelling is gone and no further meds are necessary.  

"There is medicine and there is healing. Healing requires rest and comfort, and all patients should be kept as comfortable as possible. Studies have shown a correlation between less pain and faster recovery from illness, surgery, or injury." Barak Benaryeh, DVM, DABVP. Identifying Pain in Geriatric Patients. Veterinary Team Brief. NOV/Dec 2015.

☐ Why Chiropractic is not recommended for pain for an IVDD dog www.dodgerslist.com/literature/chiropractic.htm

☐ How much does your dog weigh?

Tramadol and Neurontin, what are their doses in mg’s and how times per day given? Did the Vet say when the Depo Medrol shot would wear off?  

Please include the all important stomach protector such as Pepcid AC. Phrase the question to your vet this particular way:" Is there a medical or health reason for my dog not take Pepcid?" If there is no reason, 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.

☐ Currently can your dog wobbly walk? Move the legs at all? Or wag the tail when you specifically do some happy talk?

☐ Can your dog specifically sniff and squat and then release urine or do you find wet bedding or leaks on you when lifted up?

☐ Eating and drinking OK? Poops OK - normal firmness & color -no dark or bright red blood?

----- During conservative treatment, anytime out of the recovery suite/crate 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. 
Any trips in the car should be for needed Vet visits and the carrier or crate should be carefully padded on the sides with blankets to avoid Toni being injured from sudden braking or turning a corner.. 

The unknown is simply too scary a place to stay in. Are your ready to get up to speed on all things IVDD and fight the IVDD enemy? Excellent page to start with "Overview: the essentials" and then read all you can as soon as possible. Are you ready? Here's the link www.dodgerslist.com/healingindex.htm

My dog Tyler also has IVDD, so I know what you are going through..  sending healing thoughts and prayers for Toni!

I wouldn't take Toni on car rides unless it's crucial. Any wrong movement could hurt her. If you must go to vet use a crate padded with a pillow and rolled blankets on the sides. As for crating with her buddy, I wouldn't. You could put two crates next to each other. Otherwise she could move too much and make her back worse. After crate rest I would still crate separately. It's a part of dog pack mentality that weaker dogs feel defensive and stronger dogs may attack. Even best buddies that have never done that before.

Sorry I see Toni's a boy!

Charlotte, there are four phases of healing with a disc episode. The disc only heals with limited movement of 8 weeks. After the disc has healed, there would be, of course, no need of crate rest.

I highly recommend this page so that you see which phases require meds, how long to use them. It is good to have this background information so you in a better position to advocate for Toni. Here is the link on how conservative treatment works to heal each of the 4 phases: www.dodgerslist.com/literature/healingpage.htm

Because prednisone plays such a big roll in treating a disc episode, it is good to increase your knowledge in this area. Your knowledge is the power to fight the IVDD enemy and win. By all rights the DVM vet (not a specialist) should have known to tell you start Predisone, but the vet did not know. IF you had known, you could have advocated with a different vet. Since Toni has been in pain is it VERY clear there is still spinal cord swelling going on that Prednisone needs to get to work on. Here is the short version on how prednisone or a non-steroid anti-inflammatory (NSAID) works.



You ought to be able to call in and report pain at the CVSC since they have already seen him and his record is there. Do you not have a regular DVM vet?

Any time out of the recovery suite is a danger to the early healing disc. No car rides. Even vet visits have to be weighed for the benefit vs. the risk.  Some things can be handled over the phone such as reporting pain and  adjustments to meds.

What was the date you started 100% STRICT rest 24/7  only out for a very, very few footsteps at potty time?
STRICT means:
- no laps - no couches     - no baths       - no sleeping with you
- no crating Toni with Nathan                 - no car rides except a necessary vet visit
- no chiro therapy                                - no meandering at potty times.

Are you promptly on time giving both pain meds every 8 hours?  Wth a disc epiosde pain meds are not given on an as needed basis.  The time to stop meds, not give them is when there is  test for pain stop/taper of the anti-inflammatory drug.

D/l and print this useful med chart from here: www.dodgerslist.com/literature/crateRRP/medchart.pdf

Hi, Charlotte. It's a good sign that pain is under control. However, pain meds just mask the pain and don't work on getting the swelling down. It's that swelling pressing on the nerves of the spine that can cause nerve damage. The sooner the swelling is resolved the better. The only way to tell if the swelling is gone would be to stop the pain meds to see if there is still pain.  So do please call the emergency hospital ASAP to speak to them about starting Prednisone or at least to stop the pain meds to test for pain to see if there is still swelling and still the need for Prednisone. It can take 7-30 days for swelling to resolve so with the relapse that occurred on April 1st, it's likely there is still swelling especially since Toni hasn't been on the anti-inflammatory dosage of an anti-inflammatory since the new pain started.  More reading on anti-inflammatory usage here:
www.dodgerslist.com/literature/healingsweling.htm

Please also speak to the hospital about starting a stomach protector while Toni is on Prednisone. Or speak to Toni's regular vet who has more knowledge of Toni's health. Phrase the question to your vet this particular way:" Is there a medical or health reason for my dog not take Pepcid AC?" If there is no reason, 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 and then every 12 hours thereafter for as long as he's on Prednisone.

Unfortunately, since there was a relapse on April 1st, possibly due to too much movement before the damaged disc was completely healed, the 8 weeks of strict 100% 24/7 crate rest must start again as of April 1st.

Please let us know what the vets say after speaking with them about starting Prednisone and Pepcid AC. Healing prayers for Toni.

The neurontin is supposed to be given every 8-12 hours and the tramadol every 8. We usually give him both at the same time. His medication runs out on Friday, so I have an appointment for Thursday morning to reevaluate Toni. I called CVS and they referred me to our home vet. I will let you know what the course is after the appointment.
Toni seems to be in better spirits today. He pottied and stood for a short time. He also walked a few steps. He eats and drinks fine, and gets excited over the food. The only time I take him out of the crate is to use the bathroom, which he uses pads.

Yes, we give both pain meds every 8 hours. He gets his night dose at 12 midnight, and I have an appointment at 8 am on Thursday. So this will work out. I won't give him the morning dose, if needed, until after the vet sees him. I have famotidine and am giving it to him also. When I called to make the appointment, they insisted that the depo medrol stays in his system for 4 weeks and should take care of the swelling. I will address it again when I see the vet, as this particular vet was not there today when I called. I will let you know more after the appointment. Thank you for your help.

I am very glad that Toni is doing so well. Are the new meds taking care of his pain?

Toni keeps licking his left hind leg. I had told the vet about this, and she said that he probably has some tingling. It seems that he does it more since his meds were reduced. Is it a good idea to increase the neurontin back to one whole capsule like before? Other than that, he is doing really well.

He already is on neurontin, but the vet reduced his dosage from 1 capsule every 8 hours to 1/2 capsule twice a day. He did mess witb his leg a little before, but since the dosage has been reduced, he does it more often.

Will have this pain from now on? I hope not.

I have spoken to several vets, and called the specialty clinic. The neurologist there said the same thing as everyone else, that the depo shot (given March 18) needs to be out of his system before they can give him some prednisone, otherwise it would make him sick. I really don't know who else to ask. I have a consultation for laser therapy and/or acupuncture on Tuesday. A veterinarian will be present for this, so I will ask him as well.
Since the gabapentin is back to the original dosage, Toni is hardly bothering with his leg. He does not seem to be in any pain. I just hope that he doesn't get depressed being locked in his crate. He's always been such a happy boy, and I want him to continue to be that way.

Toni twisted around a little bit this morning and yelped. I called his vet to see about getting some prednisone. They told me I have to wait until April 18 to get it. That'll be one month from when he got the depo medrol injection. I asked them to refer me to a neurologist. So we shall see what he says.
I also have a consultation for laser therapy this afternoon. I will ask this vet for his opinion.
Toni still doesn't seem to be in any pain, it was just this quick yelp. His appetite is fine and he gets excited when I let him out of the crate for potty breaks.

Charlotte, you have just been witness with your other verts and now this one as to why it is us owners who have to know this disease. We have to do our reaserch, our reading....simply put not all vets know IVDD.

It takes 8 weeks for the disc to heal. There are no meds to heal a disc. The disc only heals with 100% STRICT rest 24/7 so that there is little movement to the back. This is a test for you. Where exactly in the 100% STRICT rest, limited movement of the back, only a few footsteps at potty time of 8 weeks do you find where PT fits in and is safe to do?

See if you get the same answer. There is no room for any PT during the 8 weeks of crate rest!  Toni can walk so he is keeping his muscles and joints in condition with his limited footsteps at potty breaks.  When it is safe for the early healing disc at the end of 8 weeks, then more physical activity can take place as you gradually introduce him back into family life.  As you approach graduation day, we have lots of good ideas how you can do that.

This is what could happen if the early healing disc is not allowed to heal but calling for activity before graduation day.  IF the still weak scar tissue forming tears the next time, not only will you have more vet bills, Toni will experience pain on the tear of the scar tissue. The next time he may suffer severe permanent damage to his spinal cord...he may be paralyzed for the rest of his life.  To me it is a simple, a no brainer. The spinal cord is of utmost important to protect with STRICT 100% rest 24/7.  Muscles will bulk up again after graduation day.

The dose of prednisone prescribed was not at the anti-inflammatory level.  It is better than no anti-inflammatory but not good enough.  See what you can do to advocate for the anti-inflammatory level that is used with IVDD. Getting the swelling down soonest possible is the goal, not lingering on has has been done for these many weeks.

Do  you have Pepcid AC now on board with the prednisone.  5mgs 2x/day?

Hi Charlotte!

All we want is for Toni to be healthy again, as well.  Paula was cautioning you, not chastising.  I am glad to hear the Vet wants to start with Laser and Acupuncture but not the Underwater treadmill until after crate rest.  Underwater treadmill is very effective in helping a dog walk again.. Many members have used that therapy with great results after crate rest is over.. 

If there is great pain or severe neuro diminishment, acupuncture or laser light therapy can be be started right away as an adjunct to pain meds and to kick start nerve cell energy production. Options: Acupuncture vet who does home visits to avoid back moving during transports. For transport to necessary visits, pad out the recovery suite extra space with a rolled up towel/blanket to prevent body shifts during braking or cornering.

The typical Prednisone dose with a disk episode is 5mg 2x/day until the taper in 5 to 7 days.. Anything under that is not an anti inflammatory dose. That is what is typically prescribed in the majority of cases.  In 15 years of Dodgerslist we have read what Vet's prescribe to our member's dogs and have witnessed through the forum the results of what medications were used, or not used and the struggle many members have when their Vet doesn't want to prescribe what is typically used by Neurologists who see many more cases of IVDD than regular Vets..  dodgerslist.com/literature/healingsweling.htm     dodgerslist.com/literature/healingpain.htm

We have also seen what doesn't work.. We have seen dogs hurt when too much activity happens to early in their recovery, and many, many relapses..  We caution our members because we care and don't want any dog to experience a relapse or more pain.. 

Read some of our members stories to get more of  an idea of what we are about!  dodgerslist.com/monthstory.htm

Comforting thoughts..