Julia's Cocoa 3/15 conserv. —Boxer/Basset/Dox Barnard, VT

Hi JK, and welcome to Dodgerslist. We are a small friendly group just going by first names. Mine is Paula what's yours?

I'm sorry to hear your Cocoa is dealing with another disc episode.

First thing is to verify that Cocoa no longer has any bladder control. When they do have full or some bladder control they will not like you expressing and fight it and that could be the reason the stomach muscles are tightening up. Lack of bladder control means if you lift them or use the sling there can be urine leaks on you or leaking in an inappropriate place, the place where they sleep!

The only way for us humans to know if there is bladder control is with the sniff and pee test. Carry outdoors best you can with a 41 lbs dog or as little walking/footsteps as possible, set on an old pee spot to sniff it. See if urine is then released. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. If urine comes out after sniffing, bladder control is returning. To truly tell if a dog is peeing requires visualizing them urinate at an appropriate time and place and then feeling the shape of the bladder for a relatively empty bladder. Let us know what you observe.

If there is indeed no bladder control yet, there are meds to help relax the bladder walls to make expressing easier.  Diazepam to relax muscles, bladder outflow relaxation agents to inhibit the internal urethral sphincter such as phenoxybenzamine or Prazosin

Are you expressing for poop?  
This info has great tips and video as a review on manually expressing the bladder as well:  www.dodgerslist.com/literature/Expressing.htm

Let us know more detail about her neuro function. Can she move her legs at all such as to reposition in the recovery suite?  Do her paws knuckle under? Can she move up to a stand by herself?

Nerves heal typically in the reverse order of the damage to the spinal cord:
1. _√_Deep Pain Sensation (Only correctly identified by a specialist.)
2. _√_Tail wagging with joy at seeing you or getting a treat or meal.
3. Bladder and bowel control _?_verified with the "sniff and pee" test.
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 place the feet.
6. Ability to walk unassisted and perhaps even run.
More info: www.dodgerslist.com/literature/healingnerves.htm

What date were the Dex tabs started?  For how many days is the 0.5mgs 2x/day before a taper started?

What did the vet think the backend pain was from: anal gland pain, pain from a UTI of burning sensation when urinating?  Pain because not all of the spinal cord inflammation was yet gone?  Dex taper days do not work on pan ful swelling.  The taper days are to test to see if Dex needs to be back up at the original anti-inflammatory dose.

This info will help you better to communicate to the vet and understand his treatment and what he is saying:  www.dodgerslist.com/literature/healingsweling.htm

Julia, when a post is made, it will appear right away. You can see all of your posts by clicking on the blue link "Julia & Cocoa" above the dog icon on the left side of the page.  We look forward to your post to learn more about Cocoa, sorry the gremlins ate your last post!

Julie, thank you for re-posting your lost post and all of the good information on meds.

Very glad to hear that now pain is in control

Do know that both the steroid, Dex, and the non-steroid anti-inflammatory Carprofen with IVDD are not pain relievers as such. I say that because it can take 7-30 days of anti-inflammatory use to resolve all the painful swelling/inflammation. So far she had 1 day of Dex injection, 7 days course of dex pills and how many days of carprofen? It is a prudent thing to taper steroids and stop NSAIDs after a course. The taper days of a steroid do not work on painful swelling. The taper is a test for pain to see if another course is needed. No one wants to use any steroid or NSAID a bit longer than getting all the swelling down as they all carry some adverse side effects.

I can well believe tramadol at such a very low dose and only 2x/day for a 41 pound dog did not control pain. If the vet had used the usual aggressvie Tramadol dose + likley 1-2 other pain meds there would not have been need for pain on the Dex taper nor a need to even be waiting for a 4 days washout before switching between the steroid and the NSAID class of anti-inflammatory drugs. What is done is done and Cocoa is in comfort.   Important to understand as some dogs may have more than one disc episode in their lifetime as you have experienced. The more we know the better we can advocate for our dogs.

How many days is the carprofen prescribed for?

You will want an understanding of what the stop date of carprofen is used for with a disc episode. Great informative article:
www.dodgerslist.com/literature/healingsweling.htm

Big pain requires big pain treatment that Gracie did not get initially. A disc episode is a very painful thing. The best pain control during a disc episode, as in people, comes with multimodal pain management: using more than one approach that addresses pain from multiple fronts. Good to have this information under your belt to best advocate for her: www.dodgerslist.com/literature/healingpain.htm

Baby wipes are good for clean ups. Brewing a pot of green tea and cooling it for dampening a washcloth will counter act the urine and leave a nice early fragrance.

If she does not want to roll on her back, that could be a sign of pain, needing an adjustment in pain meds. Do you see any 2nd confirming signs: 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.

It is ok if she turns by herself on her back, but I would not recommend you do that as it may be too much movement for the early healing disc.  Just clean as best you can by sliding a tea-dampened washcloth or a baby wipe to remove any urine from fur or skin and around the private areas.  IF you are worried about urine scald a barrier cream without toxic to dogs zinc if too much is ingested can help.

Here is one:  Aquaphor Baby or regular Healing Ointment contain same ingredients:  Petrolatum (41%)           
Inactive Ingredients: Mineral Oil, Ceresin, Lanolin Alcohol, Panthenol, Glycerin, Bisabolol
aquaphorus.com/categories/



Stay the course with strict rest as much as possible as it is with a too heavy to carry dog. Limited movement is how the disc heals...there are no meds to heal a disc.  

How are you doing with expressing, does she stay dry session to session?

Julia, about the carprofen, is it no longer being given, it was stopped on 4/8 after 2 days of use?

Carprofen was started on 4/6 NOT 4/7? In other words there was only a 3 day washout from the stop of Dex on 4/3 and the start of Carprofen on 4/6?

Julia, glad to hear no diarrah.

About the carprofen, is it no longer being given, it was stopped on 4/8 after 2 days of use?

Carprofen was started on 4/6 NOT 4/7? In other words there was only a 3 day washout from the stop of Dex on 4/3 and the start of Carprofen on 4/6?

I am very sorry that Coco twisted her back. Our dogs can do the unexpected in a heartbeat.  I am not sure if you have seen this video which shows how to use an ex-pen to make clean up easier. 


It is likely that the diarrhea was caused by an insufficient washout. Thankfully she is no longer having diarrhea. If you are giving the Carprofen continue the Pepcid AC.


I am not sure why your vet thinks that Coco should be put down. Her pain is under control, except for the incident last night). Is she happy and excited to see you? Does she enjoy having a treat? This is what quality of life is for a dog. I always like this video which shows how much an IVDD dog can enjoy life.



It can take up to 30 days on an anti-inflammatory before the swelling in the spinal cord is gone. Even after that a very few dogs have taken a small dose of anti-inflammatory long term. This is similar to how some people treat arthritis. The tramadol should be given 3X a day until there is no pain. Once the swelling in the spinal cord heals the pain should be gone.

I am not sure what to advise about the crate rest. It would depend on whether you see a real relapse going forward or not. If tomorrow she is as she was before the incident, you can continue crate rest from that point. If you are seeing a relapse, than the 8 weeks must start again. It does not hurt a dog to do crate rest but it can hurt the dog if crate rest is stopped prematurely. Dodgerslist always errs on the side of caution for crate rest. Any muscle atropy you are seeing will go away quickly once she returns to activity. Muscles build up fast but nerves heal very slowly.

Healing thoughts for Cocoa

Julie, when you use the "quick Reply" area to write in (located at the bottom of the Forum page), the button that sends your post to the Forum is the "POST QUICK REPLY" white button on the bottom left.

Julie, you have a less than ideal situation going on with your vet in regard to the disease, IVDD.  
--- Any vet who is not knowledgable that putting a dog down for IVDD is not a treatment, is not the vet for Cocoa. However, your circumstances may call for you to muster up all you have to insist on the treatment you want support for.
--- It is likely that long lasting Dex may have needed the full 7 days washout AND double stomach protection of not only Pepcid AC on board but also sucralfate to try and prevent the GI tract damage of diarrhea Cocoa had.
--- Choosing to switch from Dex to a lessor anti-inflammatory, having to deal with washout, stomach protection....Why???? the switch in the first place is the question!
--- Now that you know Cocoa has shown one or both of these anti-inflammatory drugs cause her problem, then take no more chances. Call and advocate for sucralfate to be on board.
--- The anti-inflammatory really should not be hap hazzardly given, it needs to be given on time daily to fight the pain of inflammation over the course of 7-30 days, that is why we do NOT consider it a pain reliever. Two stomach protectors on board can very likely make it possible to dose carprofen on time every day.
-- Cocoa is on only one pain med. Because a disc episode has three (3) sources of pain, that is why three different pain meds are typically used.  Advocate for methocarbamol and gabapentin to be added.
-- The dose of tramadol being prescribed is almost like not prescribing any tramadol for a 41lb/ 18.6kg dog!
The usual in controlling pain is to Rx Tramadol at the higher end of the mg range AND promptly every 8 hours which may be even two 50mgs tablets every 8 hours for Cocoa...see the references below. They are not for you to self prescribe but to able to advocate for Cocoa to get her pain in control.

In this day and age there should be no debate in the veterinary community on medically managing pain with IVDD.  Pain just can't be allowed PERIOD just the same as it is understood pain must be managed for human patients. Any vet that is not up with current standards of pain management is not the vet for an IVDD dog. You will have to do steady battle instead of getting support. It will make all the difference in the world to hire a more IVDD knowledgable vet if you have another in your town or a nearby one.  If you are a strong person, have good persuasion skills, have  done your homework, you may be able to work with your current vet present the kind of help Cocoa needs. Vets take an oath to help animals not railroad you into killing yours.  

Keeping a med chart can help you see the relationship of med times and pain. Have that info readily available to as feedback to the vet on what you want to see in med changes (advocating on behalf of Cocoa, just the same as you would do for yourself to your own doctor.)

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

Julia, I recommend BEFORE pressing the "Post Quick Reply" to first copy your post. That way should the computer gremlins mess up you will still have what you have written in memory and can just paste it into a new post and try again. So sorry you are having these problems....very, very frustratiing.

Let us know your city in Vermont. You can also check out our member directory for vet recommendations: www.dodgerslist.com/literature/surgerycosts.htm

Sometimes a consultation with a specialist even if surgery is not a consideration is to get meds right that a local general vet does not feel comfortable in prescribing. But sounds like now pain IS in control and you are looking for a new vet. A specialist could also help you through conservative treatment if another DVM is not near enough to your home in central Vermont.

Check adjacent states that may still be close enough to you.

Good news that Cocoa is now comfortable.

There is so much to learn about IVDD and we pet parents have to learn this when we are worried about our dogs and how best to care for them. The more we learn the better we can help our dogs.

My Frankie was paralyzed overnight a few years ago. I was in shock and I remember how much there was to learn and understand.
 
Let us know what the specialist has to say. We will be looking forward to hearing.

Julia...my Baxter has had an eddies wheels for 6 months...he loves it! He zooms down the driveway every morning chasing deer and squirrels. It provides so much exercise for him. Good luck with cocoa.

Thanks Joann and Paula, for your replies. Joann, I've been in touch with Eddie's and they would welcome a visit to measure and evaluate Cocoa whenever we are ready. They seem like great people to work with.

Paula, your meds list plus dates given to Cocoa matches my notes. I will try a medication stop as of this evening (she has had the Tramadol plus Carprofen/Pepsid this am 4/19).

41 lbs
Dex IV on 3/15
Dex as of 3/16: 0.5mgs 2x/day for 7 days STOPPED 4/3a.m.
Carprofen as of 4/7p.m.: 50mgs 2x/day for 2 days STOPPED 4/8
               as of 4/10: 50mgs 2x/day for 1 day
               as of 4/11: 50mgs 2x/day for 8 days STOPPED 4/19
Pepcid AC 10mgs 2x/day  STOPPED
Tramadol 50 mgs 3x/day  STOPPED]

Tomorrow I expect to get the rear and front harnesses and I'll see how she responds to going a few steps and being off meds. She is not stoic and will let me know if anything hurts. Earlier, I tried a towel but that slipped out of my hands and a homemade sling didn't work at all. Her little butt needs some fresh air! I did get the Aquaphor ointment. I amazed at how much I didn't know before about that end of my dog.

My last vet visit to check Cocoa's UTI went well but I really should have asked about her meds - I was so happy to hear about the urine results I forgot to ask. We did discuss ways to prevent that happening again and also issues related to my 15yr old Border Collie/Keshund mix - Paula, you are good at keeping me focused.

Julie sounds like things are settling into ago routine for all.

Before any least aggressive range of motion PT would start it is normal to be off all pain meds (gabapentin). The 100mg dose 1x/day is like not giving any if it were for pain AND you are not reporting pain during the day when gabapentin would have worn off.

What specifically do you observe that shows she anxious that gabapentin is solving as an aid to keeping her clean?

So here is the type of least aggressive passive PT to begin and do until she is off of crate rest (graduated on May 10) The information in PINK applies to paralyzed legs during conservative treatment:
www.dodgerslist.com/literature/massagepassiveexercises.htm

At graduation day, then you can begin a gradual intro back to active PT safely as the disc has healed (see in the video below)...do check it past your PT person. There area very useful therapies like underwater treadmill if available in your area. On graduation day do let us know we can offer other things you can do at home.
Appropriate physical therapy can help maintain the muscles with lost nerve connection. Therapy keeps muscles in optimal condition while in wait